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Care Home: The Old Vicarage [Otterton]

  • Ropers Lane Otterton Budleigh Salterton Devon EX9 7JF
  • Tel: 01395568208
  • Fax:
  • Planned feature Advertise here!

  • Latitude: 50.658000946045
    Longitude: -3.3010001182556
  • Manager: Mrs Susan Gladys Tisdall
  • Price p/w: ~
  • UK
  • Total Capacity: 26
  • Type: Care home only
  • Provider: Mr Michael John Parkin,Mrs Patricia Ann Parkin
  • Ownership: Private
  • Care Home ID: 16381
Residents Needs:
Old age, not falling within any other category, Physical disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 3rd March 2009. CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

For extracts, read the latest CQC inspection for The Old Vicarage [Otterton].

What the care home does well The home’s thorough admission procedures help to ensure that the needs of people who go to live at the home can be met there. They are supported and cared for in a person-centred way, being enabled to have choice and control in their daily lives, and having their privacy and dignity respected. The stable, well-trained and well-supervised staff team are able to provide a safe level of care at all times. They clearly enjoy their work and take pride in providing good quality care and services. Individuals’ health needs are met through involvement of relevant communitybased professionals. With organic vegetables or fruit from the home’s gardens, and notable events or dates celebrated regularly, mealtimes are both healthy and social occasions. People’s quality of life is added to by contact maintained and enjoyed with their families, friends and the community around the home. The Old Vicarage is homely, clean, and well-maintained, being continually refurbished to maintain high standards of decor, and with ongoing improvements made to the accommodation and gardens in response to residents’ suggestions, views and needs. People can feel confident that any concerns, complaints or issues they raise with the home will be listened to, and that the home acts to safeguard them from abuse. The home is well managed, with the best interests of those who live there made a priority. What has improved since the last inspection? The home has covered radiators, to prevent accidental burns and scalds. Robust staff recruitment procedures are used, to help to protect people living at the home from unsuitable individuals. We have been notified of any serious occurrences at the home, as required by the Care Homes Regulations 2001. What the care home could do better: More detail in records of care given, and in the subsequent evaluations of the care originally planned, would help to ensure that individuals’ current and changing needs are met.Positive developments were seen, but aspects of medication administration and recording practices must be improved further to protect and promote people’s wellbeing. Better evidence of attention to some health and safety matters would also show that people’s welfare is promoted as fully as possible. CARE HOMES FOR OLDER PEOPLE The Old Vicarage [Otterton] Ropers Lane Otterton Budleigh Salterton Devon EX9 7JF Lead Inspector Ms Rachel Fleet Key Unannounced Inspection 3rd March 2009 10:00 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 [Otterton] DS0000022065.V374739.R02.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 [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage [Otterton] Address Ropers Lane Otterton Budleigh Salterton Devon EX9 7JF 01395 568208 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) Mr Michael John Parkin Mrs Patricia Ann Parkin Mrs Susan Gladys Tisdall Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability over 65 years of age of places (26) The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd March 2008 Brief Description of the Service: The Old Vicarage provides accommodation and personal care, for up to 26 older people who may also have a physical disability. Nursing care is not provided other than through the local community nurses. The home is in the village of Otterton in East Devon, midway between Sidmouth and Budleigh Salterton. Facilities in the village include a church, village hall, post office, pub and general stores. The building is described in the home’s brochure as a gracious and elegant house, mainly Georgian but with Tudor origins, that has been lovingly restored and converted to use as a care home. The home is fully carpeted, centrally heated, and exceptionally well decorated and furnished. Accommodation on the ground and first floor has level access, aided by a passenger lift between floors. The home has a hairdressing salon room. The home has 24 en-suite bedrooms, two of which are registered for use as double bedrooms. The owners have asked us to include here that the home’s policy does not permit sharing by strangers, thus the double rooms are occupied either by one resident (- as during this inspection) or occasionally by couples. Bedrooms overlook the gardens, and some have views of the surrounding countryside and village. There is level access to the gardens from both the ground and first floors, with additional garden outdoor seating provided in response to discussions with people living at the home. A circular walk has recently been created around the home, through well-kept gardens. Soft fruit and vegetables are grown here organically, for use in its kitchen. There is ample parking on site. The home has cars and several staff insured to provide transport for those living at the home, at no cost to the resident. This includes transport to medical appointments, with a staff escort. At the time of this inspection, weekly fees were £630 - £840, dependent on bedroom size. Fees may be negotiated for extra care. They did not include costs of chiropody, hairdressing, newspapers, personal shopping, private phone The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 5 facilities, guests’ meals (£3.50-£5), and any entry tickets required on outings arranged by the home. A copy of our latest inspection report is available at the home on request. The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. This key inspection took place as part of our usual inspection programme. Our unannounced visit to the home took place over 10 hours on a weekday. Before our visit, we had sent the home a questionnaire (the Annual Quality Assurance Assessment, or AQAA), which was returned by Mr & Mrs Parkin, the home’s owners. The AQAA included the homes assessment of what they do well, any plans for improvement, information about people living at the home, staffing, policies, and maintenance of facilities. We had also sent surveys to the home for them to give to 10 people living at the home and to 10 staff. We also sent surveys to seven health and social care professionals who support people living at the home. We received nine surveys back from residents, eight from staff, and six from the professionals. We spoke in depth with four of the 19 people living at the home on the day we visited, and met others more briefly. We talked with a visitor and seven staff (care and ancillary staff), as well as looking around the home and its gardens. We case-tracked three people, which means we looked in more depth at their care. They included someone new to the home, someone with more complex or changing needs, and someone who did not have relatives to support them. We read their care records and related information (medication records, personal monies records, etc.). We met them, observed some of the care and attention given to them, speaking to staff and looking at the accommodation in relation to their needs. We checked staff recruitment files, information on staff training, quality assurance information, and records relating to health and safety (such as accident and maintenance records). We ended our visit by discussing our findings with Mr & Mrs Parkin who, with Marion Vicarage (the person in charge when we arrived and the home’s administrator), assisted us fully during the inspection. Information included in this report is from all these sources, and from communication with or about the service since our last inspection. The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: More detail in records of care given, and in the subsequent evaluations of the care originally planned, would help to ensure that individuals’ current and changing needs are met. The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 8 Positive developments were seen, but aspects of medication administration and recording practices must be improved further to protect and promote people’s wellbeing. Better evidence of attention to some health and safety matters would also show that people’s welfare is promoted as fully as possible. 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 [Otterton] DS0000022065.V374739.R02.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 [Otterton] DS0000022065.V374739.R02.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): 3. The home does not provide intermediate care (Standard 6). Quality in this outcome area is excellent. Comprehensive pre-admission and admission procedures help to ensure that the needs of people who move into the home permanently can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Of the responses in surveys returned by people living at the home, all said they had had enough information about the home before deciding to live there. Some people we spoke with told us they had had a short visit to the home; others had discussed the home with family or health professionals. Some said a ‘trial stay’ period had been discussed with them. The Parkins told us everyone has an initial trial stay, for which they are charged the home’s lowest weekly fee. We were told that when a person had decided they definitely wanted to move in, they were sent a letter explaining the terms and conditions of residency. The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 11 When they moved in, they were given a copy of the Resident’s Handbook that gives full information about the home. We saw this in a vacant room. We looked at information obtained by senior staff at the home before people moved into the home. We saw that they had gathered detailed information on each person’s social, personal and health care needs, which enabled staff to decide if the person’s diverse needs could be met at the home. The information included people’s life stories, their medication, any risk of falling, etc. The Old Vicarage [Otterton] DS0000022065.V374739.R02.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 – 10. Quality in this outcome area is good. People are supported in a person-centred way, with respect shown for their privacy and dignity, although systems for evaluating and recording care need development to ensure that their needs will be met. Their health needs are met by the home working well with relevant community professionals. However, medication procedures are not robust enough to fully safeguard people’s welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at three people’s care plans. All contained recent assessments carried out by a senior staff member, including the person’s abilities, interests, preferences and needs. Assessments had very person-centred detail, such as the person’s appetite and what assistance they needed with meals, their state of mind, any equipment/aids they needed, arrangements for their personal monies, and assistance the person required on specific occasions that was The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 13 different to the help they routinely required. Two had the individuals’ life stories. In two cases, the assessments were reviews of their care needs. These had been signed by the relevant individual, indicating they had had the opportunity to discuss the information in their own care plan. The third, for someone relatively new to the home, had not been signed by them. Notes made by care staff showed that advice and treatment had been sought in a timely way from relevant professionals, when people had health problems. Information about the rest of the person’s daily life, recorded daily, was kept in a separate place to the person’s care plan and the health-related notes. We discussed with Mrs Parkin there was a need to ensure this personal information was kept in line with the principles of the Data Protection Act 1998, and in a way that enabled good holistic evaluation of care planned for individuals. At a subsequent meeting with Mr & Mrs Parkin, it was agreed that daily notes made by staff and used to inform handover meetings would be destroyed each day, after any relevant information had been transferred to the individual resident’s care plan and daily records. It was not clear, for example, if people were getting the care indicated in their care plan. One person told us staff said they would take them for a walk but that this didn’t always happen. The person’s care plan included that they were to have two walks a day, with staff, to address a specific problem. Daily notes made by staff did not include the person had had two walks every day. Thus the effectiveness or otherwise of the care planned to address the problem could not be evaluated properly. Of 9 surveys returned by people living at the home, 7 said they always received the care and support they needed, from staff who listened and acted on what the person said. Two said they usually or sometimes got the care and support they needed, with one suggesting that having assigned carers would be helpful rather than several different carers. Staff surveyed felt they were always given up-to-date information about the needs of people they cared for. Housekeeping staff also said they were informed as necessary about people’s needs, so that they could prepare bedrooms suitably for new people, carry out their role without adversely affecting people, etc. We heard staff talking with people at the home, clearly aware of how they had been recently, including how well they had been eating, keeping to their usual routine (or otherwise), etc. Of the surveys returned by people living at the home, all said they got the medical support they needed. Health professionals surveyed said the home always or usually sought advice and acted on it to manage and improve people’s health needs. Their comments included, ‘Personal care…good ambience,’ and ‘Excellent holistic care…friendly caring environment.’ The home The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 14 provides free transport in one of its cars to medical appointments; one person told us a member of the care staff accompanies people, free of charge, on such appointments. Coincidentally, the people we case-tracked all had sight problems. One confirmed that staff explained what and where food was on their plate at meal times, as well as introducing themselves when they entered their bedroom. Another person, who we saw had the home’s newsletter in its usual printed format, said staff read it to them. People we met at the home, and health professionals surveyed, were satisfied with how medications were managed. We were told that one person was selfmedicating. Their medication was received by the home, and recorded as is required before being handed to the person. The person told us that staff checked their medication regularly, to ensure it was being taken as prescribed. We noted some issues relating to administration and record-keeping. Some hand-written alterations on medication charts had not been signed and dated. A medication prescribed for administration twice a day according to the medication record, had only been given once a day; staff followed this up during our visit. Two skin creams prescribed for the same person had not been signed for, nor an alternative explanation recorded. One person was prescribed a medication that could be used for two very different health problems, for use when needed. There was nothing in their care plan or on the medication administration record to indicate in what circumstances it should be used. We were told that one person was given their prescribed injection by senior staff at the home, a district nurse having delegated this action to two named staff. We will look at the records of this arrangement on our next inspection, as the person in charge during our visit was not sure where they were kept. We observed a staff member giving out medication appropriately. However, medicines were taken around on a domestic trolley, without secure storage possible should the trolley be left in an emergency, for example. On one occasion, we found it unattended whilst staff were with someone elsewhere. At a subsequent meeting held with the provider, they told us the staff member concerned was dealing with an emergency. Controlled drugs were stored securely, with appropriate stock levels and records kept for items we checked. We advised that senior staff check that a cupboard used for other medications met required specifications. There was a dedicated, lockable fridge for medicines needing cool storage. We advised daily temperature records included minimum/maximum readings, as well as a daily reading, to ensure that storage conditions remained appropriate over time. Health professionals surveyed said the home always or usually respected individuals’ privacy and dignity. People we asked said their privacy was The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 15 respected; staff did not talk over them, or speak inappropriately about other people at the home, for example. The home’s ‘Residents’ Charter’ includes the right to privacy for residents, their belongings and their affairs. Bedroom, toilet and bathroom doors had locks. We were told people could have a key for their bedroom; people who did not have a key told us they did not feel they needed one. The Old Vicarage [Otterton] DS0000022065.V374739.R02.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 – 15. Quality in this outcome area is excellent. The home enables people to enjoy choice and control in their daily lives. Their quality of life is added to by the links they are helped to maintain with their families and the community around the home, as well as by the home’s commitment to making mealtimes healthy and social occasions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The latest monthly newsletter was on the notice board, which had also been given to each person living at the home. It was in clear, large print and listed local as well as in-house events. A new supply of library books was delivered by the mobile library during our visit, including large print books. People told us about the home’s ‘trolley shop’, and said that they could place orders if what they wanted wasn’t on it. We saw bedrooms were being fitted with televisions, ready for the change to the new digital service. The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 17 A ‘Residents handbook’ given to each person includes a list of the home’s internal telephone numbers. This enables people to ring each other within the home, or contact the kitchen staff and night staff in addition to using their call bell. We were shown an upper lounge which was used mainly for activities – there was a large screen for watching DVDs (the ‘Film club’ was held regularly, as one person confirmed), a pianist visited regularly to play the electric piano there for people, a fortnightly exercise session was held, etc. Someone living at the home felt the musical entertainment was very good. All nine surveys from people living at the home said there were always activities arranged by the home that they could take part in. One added, however, that activities were not always suitable for someone with sight and hearing problems. Mr Parkin told us that staff were sensitive to people’s disabilities, and some had attended training that enabled them to experience for themselves what it is like to have impaired sight or hearing. The home has a smaller second dining room, which is available for people to use to entertain visitors if they wish. People told us they could have visitors at any time. One person told us the local vicar visited the home regularly, with another saying people were given communion at the home. There was a system for posting people’s letters for them. The home holds an annual coffee morning with stalls, to which family, friends and the local community are invited. The event raises funds for the local primary school, with a smaller contribution to local charities chosen by residents and staff. Of 6 health professional surveys returned, 4 indicated that the home always supported individuals to live the life they chose, with the other 2 indicating the home usually supported individuals to do this. People we spoke with said staff were flexible, and they were free to do what they wanted to do - ‘able to do your own thing’, as one said. They confirmed that they were not charged for using the home’s transport. Some people told us they went out independently, some returning late in the evening. Another told us they enjoyed using a new bathroom, which they were able to use independently. The home has two double rooms, but people only share these if they choose to. During our visit, all rooms were singly occupied. The home grows its own produce organically, with one person telling us they were looking forward to eating the rhubarb currently being grown. The majority of people surveyed said they always enjoyed the food. Their comments included, ‘Extremely good food, always fresh,’ and ‘Can ask if I want something different and it will be done.’ We noted a chocolate and pear The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 18 gateaux on the week’s menu, and were told it would be homemade – ‘Everything’s homemade here!’ The week’s menu also included two roasts, and traditional dishes such as grilled plaice, lamb hotpot, and sausage casserole, with crumbles, trifles, fruit tarts, etc. for dessert. A ‘St David’s Day’ lunch had been served in the days before our visit. One person told us where the weekly menu was displayed. We heard staff asking people what they wanted for their next meal, discussing the options, etc. Somebody told us they couldn’t eat a lot of things so they rang the kitchen staff, to discuss alternatives as necessary. During lunch, we heard staff ensure someone had vegetarian sausages (as they preferred) instead of the meat ones in the casserole eaten by other people. One person said they were a small eater and just ate what they could, since meals were plated in the kitchen. Senior staff said vegetables were served in bowls at the dining tables for people to help themselves, however. Someone who chose to eat in their bedroom said the food was always hot when it was brought to them there, adding ‘Perfect!’ The Old Vicarage [Otterton] DS0000022065.V374739.R02.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. People can feel confident that any concerns, complaints or issues they raise with the home will be listened to, and that the home acts to safeguard them from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure was displayed prominently. The Parkins said they would update our contact details on it. The home’s AQAA stated the home had not received any complaints, with efforts made to address issues before a complaint became necessary. We have not received any complaints about the service since our last inspection. All those returning surveys, as did people we spoke with, said they knew who to speak to or how to make a complaint if they were not happy. Their comments included, ‘Feel very free to discuss any matters with staff at whatever level depending on topic to be discussed’, which was echoed by another, both saying they had never had to make a complaint. Health professionals who replied said the home responded appropriately if they or someone living at the home had raised concerns. The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 20 Staff surveys also reflected that they felt able to voice any concerns and that they would be supported by senior staff. They said they knew what to do if someone had concerns about the home. Staff told us they had had training on safeguarding. They were aware of their responsibility to report bad practice, and aware of some outside organisations to whom they could report concerns to if necessary. Most bedrooms had a lockable facility, so that people could safely store any items that were of value to them. One person had been provided with a safe. A careful record was seen in one person’s records, where they had handed in a valuable item for safekeeping. All nine surveys from people living at the home said they had received a contract with the home. The Old Vicarage [Otterton] DS0000022065.V374739.R02.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, 21, 25 & 26. Quality in this outcome area is excellent. People have a homely, clean, and well-maintained place to live, with ongoing improvements made in response to their suggestions, views and needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Décor, furnishings, interior and outdoor areas were maintained to high standards. As rooms become vacant, they are thoroughly cleaned, decorated and refurbished as necessary, and we were shown one such room. We were told that pictures, shelving, etc. will be put up in line with the wishes of a room’s new occupant, by the home’s staff. People we spoke with were satisfied with the facilities in their room (heating, ventilation, lighting, hot water supplies, etc.). They also said they had not encountered any hazards and felt they could move around the home safely. The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 22 The accommodation throughout was pleasantly decorated, bright, and furnished in keeping with the style and age of the house. There is a continuous programme of refurbishment, with a new carpet soon to be fitted in a lounge. Somebody who lived at the home pointed out the new settees in the lounge, adding ‘You’ve only got to ask for it, and you’ve got it.’ A level access shower had been fitted since our last visit, with a shower chair and a place for toiletries. Someone told us they enjoyed this facility, which they used regularly. We also saw a new variable-height bath, with a hairwashing shower-hose, for safer use by staff. An easier toilet flush had been fitted in one en suite, for someone with a particular disability. The gardens had been further developed since our last visit, providing even more accessible areas for walking, sitting and enjoying views of the flowerbeds, trees, etc. A circular, level access walk had been created in response to suggestions by people at the home, using natural materials recycled from other parts of the building or its grounds. It was clear from people we spoke with that they really valued being able to see or go out into the gardens. Fire extinguishers we looked at had been serviced recently. Routine emergency lighting and fire alarm checks had been recorded, although fire extinguishers checks had not been. Mr Parkin said this would be rectified. Requirements were made at our previous inspections to eliminate the risks from hot radiator surfaces. The AQAA received prior to this visit confirmed our last such requirement was met, so risks were now controlled. Radiators we saw during our visit had been covered. People surveyed said the home was always fresh and clean, as noted on our unannounced visit. Their comments included, ‘Meticulously so,’ and ‘Housekeeping team very helpful.’ Housekeeping staff said that since there were 2-3 of them on duty (as on the day of our visit), they were able to move furniture together to enable weekly thorough cleaning of rooms. We found all areas were free from any malodours. Liquid soap and disposable towels were available around the home. We saw disposable gloves and aprons were also available to and used appropriately by staff. Chutes from each floor to the laundry reduced the movement of laundry around the home. Soluble bags were used for soiled laundry, reducing the need to handle affected items. Staff confirmed they do not hand-rinse items. We saw washing machines had sluice cycles and other programmes for thorough cleaning of laundry. Soap was provided when we noted out there was none at the handwashing sink. Three specific care staff had responsibility for dealing with the laundry, with an assistant responsible for tidying people’s drawers, etc. Staff confirmed food freezers kept in part of the laundry were not accessed while the laundry was in operation. The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area is good. People’s care needs are met by a stable, well-trained and supervised staff team, who provide a safe level of care. The home’s improved recruitment procedures help to protect people from unsuitable staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of surveys from people living at the home said staff were ‘always’ available, as did those we spoke with. One, which said they ‘usually’ were, said staff answered their requests for assistance as soon as they had finished attending to others. A visitor told us they didn’t have to wait long for staff to let them in at the front door. Staff also indicated they felt there were always enough staff to meet people’s needs. During our visit, there was a relaxed atmosphere although staff appeared continually occupied. Care staff were supported on the day of our visit by three housekeeping staff, a carer responsible for laundry, two catering staff and maintenance staff. The current week’s rota showed that in the mornings there were three care assistants on duty, and two in the afternoon/evening, as we found. At night, there was one awake care assistant, with a sleep-in care assistant available to assist if needed. The telephone extension for the sleep-in staff was given to The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 24 residents. Catering staff were available at all mealtimes, and a manager was on call if one was not on duty at the home. All health professionals surveyed said the care staff always or usually had the right skills and experience to support individuals’ diverse health and social needs, which staff surveys reflected also. One said staff were ‘very caring and attentive, helpful…with a good knowledge of the residents…would be happy to have my relative here.’ People we spoke with were generally very complimentary about the care assistants and senior staff, and their willingness to assist people; some staff were given particular praise, two people felt some staff were more patient than others. The home’s AQAA noted that no agency staff are used at the home, and all staff speak English well. People indicated this was the case during our visit. Staff we spoke with clearly knew individuals and their preferences very well. When we asked if night staff were involved in the life of the home, we were told that the majority worked day shifts as well, and the Head Night Carer attended the regular managers’ meetings. We looked at the recruitment files of three care staff recruited since our last inspection. We found that required information had been obtained - including two written references, full employment histories and a full police check before individuals started working at the home. It was also recorded that each had been given a recognised ‘code of conduct’ for social care staff. Staff surveyed were satisfied with the induction they received, as well as subsequent training and support from senior staff or management, who met with them regularly. Staff we spoke with had been at the home some years, and were clearly very happy working at the home. Information given to us during our visit showed that of 23 care staff, 13 had a National Vocational Qualification (NVQ) Level 2 or an equivalent, thus exceeding the 50 qualified staff recommended in the National Minimum Standards. An external trainer was at the home during our visit, working with a staff member taking a NVQ3 (in Care) course. Staff told us they had been on courses recently that included learning about falls, personal care (including catheter care), diabetes, nutrition and end of life care. People we case-tracked had sight problems. Staff told us that training on sight problems was being arranged through the optician who visited the home regularly to carry out sight checks. Some were also covering the topic in their current care course. They had also had training on infection control, fire safety, and at least a quarter had had an update on continence. Senior staff also gave training on any new equipment before individual staff used it. The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is excellent. The home is well managed, with the best interests of those who live there made a priority. However, there is insufficient evidence of attention to some health and safety matters to show that people’s welfare is promoted as fully as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person living at the home said that it ran smoothly seven days of the week, which others reflected. Sue Tisdall, registered manager, originally trained as a nurse. She has many years of experience in care home management, achieved a social care management qualification, is the home’s manual handling trainer, and is an ‘NVQ’ assessor. Both she and the home’s The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 26 administrator have attended recent training on wider care issues, such as the Deprivation of Liberty Safeguards, and the Mental Capacity Act 2005. The home’s owners, Mr and Mrs Parkin, are fully involved in the life of the home, and requirements made at our last inspection had been addressed. Two other senior staff at the home have nursing qualifications. The home’s self-assessment in the AQAA did not detail quality assurance or health and safety aspects of the service in the given section. However, some information was included elsewhere and gained on our visit. People living at the home, and staff, told us that Mr & Mrs Parkin would be holding an informal meeting in coming days, to discuss any matters people wished to talk about. Some told us they had raised matters for discussion in the past, and were happy with how those meetings had gone. The AQAA said a suggestions box was being reintroduced to give people the opportunity to make suggestions or raise concerns anonymously. There were several examples of improvements or development of the home made in response to people’s suggestions, new needs, etc. The garden, for example, and where an easier toilet-flush mechanism had been fitted for one person who had difficulty using the previous one. Staff comments included that they felt ‘extremely well supported by senior staff, matrons and colleagues,’ and ‘It makes a refreshing change to feel valued by your employers’. They felt there were good staff communication systems, with daily handovers, regular management meetings for heads of departments, and an annual staff meeting. We were told that no-one at the home acts as appointee for residents, although the home kept personal monies for some. Only two senior staff handled this money usually. If they were not available when someone wanted their money, staff could access the home’s petty cash. We found cash held matched the balance shown on individuals’ records, with transactions also noted here, for those we looked at. Where possible, receipts for purchases had been retained, but we noted no signatures were kept to verify transactions. This would be good practice. A three-monthly copy of the account could be provided to individuals or their relatives on request. Some people were billed in arrears for some expenditure (such as hairdressing or chiropody). Staff confirmed they had taken part in fire drills, some of which were held without warning. Someone living at the home who walked independently told us they heard the fire alarms being tested, but had not been involved in any drills. Care plans we saw did not include what support people might need individually in the event of an emergency such as a fire, and we were told this was not part of the home’s fire risk assessment either. We saw an oxygen cylinder in a bedroom, but with nothing externally to warn of the potential hazard in the room in the event of a fire. Mr Parkin has since informed us this The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 27 has been rectified. We have advised he contact the local fire authority about fire-related matters discussed during this inspection. A training programme overview for 2009 showed that all but one staff had had an infection control update, and that by the end of March 2009, all staff would have had a fire safety update. One of the housekeepers said they had had very good training on safe handling of household chemicals or cleaning materials, as well as a ‘very thorough first aid course’ provided by an external trainer. Kitchen staff were aware of the current food safety guidance (‘Safer food,’ etc.). The AQAA showed that all kitchen staff were trained in food hygiene, and that there was dedicated time for regular thorough cleaning of the kitchen. Staff confirmed there was always a first aider on duty, and we were told some staff had had recent training relating to falls. Two people who had had falls told us staff had responded quickly at the time and helped them appropriately, although one would have liked them to stay a bit longer after the accident. The only suggestion in staff surveys for improvement was ‘better equipment in relation to first aid’, but we were not able to clarify this comment. Staff told us they felt they had safe working environment, with sufficient equipment to look after the current residents properly. One told us that the environment such as people’s bedrooms was reviewed regularly to ensure changing needs could be met. Someone told us they didn’t use their reading lamp currently because the home had found it to be faulty during their routine testing of electrical items. The AQAA showed utilities and the home’s equipment had mostly been checked or serviced in the last year, although it said that gas appliances had been serviced over a year ago. Mr Parkin has since confirmed an appropriately qualified person will provide confirmation of the safety of the oven within 3 weeks. We saw evidence of the recent servicing of hoists. We were told that no records were kept of regular, routine safety/maintenance checks such as hot water temperatures or window restricting devices. It is good practice to keep such evidence, and we have advised Mr Parkin to seek advice from the local Environmental Health department, which has a particular role regarding health and safety in care homes. Mr Parkin subsequently provided evidence of systems in place at the home for monitoring the safety of the environment. The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X 4 X X X 3 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement You must make arrangements for the safekeeping and safe administration of medicines in the home. This is particularly regarding: Provision of safe securable delivery/transport systems for medication administered to people living at the home. Evidencing that all medication, including topical preparations such as eyedrops & skin creams, is given at the prescribed frequency, or recording why it has not been given as prescribed. Ensuring that there are clear directions available to staff on how and when medicines are to be used, if they are prescribed for use “when required”. Timescale for action 15/04/09 The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 30 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 OP7 Good Practice Recommendations It is recommended that a) There is sufficient detail in records of care given, and in subsequent evaluations of the care originally planned, so that it is clear whether or not each individual’s needs are being met. b) This personal information is kept in accordance with good practice guidance and data protection laws. It is recommended that the fire evacuation needs of individuals are recorded in people’s personal records, ensuring they and staff are aware of what they should do in the event of a fire, to meet their health & welfare needs. It is recommended that there are effective systems to verify the correctness of hand-written alterations on medication charts (such as two appropriate people checking, signing and dating such entries). It is recommended that two people verify and sign transactions involving the personal monies of people living at the home, as an additional safeguard to protect their interests. It is recommended that you seek clarification from the local fire authority on fire safety matters such as oxygen storage and evacuation needs of individuals with regard to the home’s fire risk assessment. 2 OP7 3 OP9 4 OP35 5 OP38 The Old Vicarage [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 31 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 [Otterton] DS0000022065.V374739.R02.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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