Care Home: The Old Vicarage (Staverton)

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What the care home does well People are happy with the service they receive and feel able to raise any concerns which they may have. People have regular access to health care services and good relationships have been developed with professionals such as GPs and District Nurses.The Old Vicarage (Staverton)DS0000057134.V377865.R01.S.docVersion 5.2Staff are aware of their responsibilities of reporting any allegation or suspicion of abuse. Robust recruitment procedures are in place to ensure all prospective staff are suitable to work with vulnerable people. Regular staff meetings are held and all staff are expected to attend so that they are kept up to date with information. Staff receive regular staff training so that they can develop their knowledge and skills on an ‘on going’ basis. What has improved since the last inspection? All assessment documentation has been reviewed and all assessments seen were detailed and reflected the person’s needs and the support they required. All care plans have been fully reviewed with a new system implemented. The plans are now detailed and person centred. The information clearly reflects people’s needs and the support they require. A system for regularly reviewing the information within care plans is now in place. People have their risk of developing a pressure sore assessed. Measures to minimise any potential risk are put in place and discussed with the relevant health care professional. People’s wishes in terms of resuscitation are now only identified within care plans if they have been specifically discussed and agreed with the person’s GP and family members. Care plans now contain information about medicines which are prescribed to be taken as required. Guidance which identifies when these medicines should be administered is in place. The medicine administration systems have been reviewed and as a result, only one member of staff completes each ‘drug round.’ This is safer practice and will minimise any risk of error. The medication administration record now shows when staff have assisted a person with the application of a topical cream. A copy of the Safeguarding Vulnerable Adults protocol is now available within the home for staff reference. The dining room has been redecorated with new carpet fitted. New lighting has been installed in an upstairs toilet. Covers have been fitted to radiators in the communal areas to ensure people’s safety.The Old Vicarage (Staverton)DS0000057134.V377865.R01.S.docVersion 5.2An activity organiser is now in post and greater opportunities for social activities are available to people. Additional ancillary staff have been appointed to assist care staff with tasks such as serving drinks and meals. Additional bank staff have also been recruited which minimises the potential of needing to use agency staff. Potential risks such as carrying hot food on trays from the kitchen to the dining room have been risk assessed. Measures to minimise the risk have been implemented. Recommendations made at a recent environmental health inspection of the kitchen have been fully addressed. What the care home could do better: Consideration should be given to ensuring all personal records remain securely stored. Pressure relieving equipment and other measures to minimise the risk of developing a pressure sore currently in place should be identified within the person’s care plan. The medication policy and procedure needs to be updated to reflect the changes in medication administration. The frequency of the checks to ensure the hot water is maintained at a safe temperature could be improved upon. While acknowledging that some areas of the home have been redecorated, other areas require some refurbishment. Some carpets would benefit from replacement. The carpet in the corridor is beginning to fray in places which may cause a trip hazard. This needs to be made safe with consideration then given to the carpet’s replacement. The conservatory roof is in need of some repair as it was leaking in one area. While the accessibility of the laundry to people using the service has been risk assessed, all substances such as fabric conditioner should be safely stored. Some people should be asked to deposit money for safekeeping on a more regular basis so they have the required amount for their daily needs. Key inspection report CARE HOMES FOR OLDER PEOPLE The Old Vicarage (Staverton) The Old Vicarage Staverton Trowbridge Wiltshire BA14 6NX Lead Inspector Alison Duffy Key Unannounced Inspection 09:15 27th November 2009 DS0000057134.V377865.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage (Staverton) Address The Old Vicarage Staverton Trowbridge Wiltshire BA14 6NX 01225 782019 01225 784060 info@equality-care.co.uk 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) Equality Care Ltd Mrs Gretta Jane Mackenzie Care Home 21 Category(ies) of Dementia - over 65 years of age (7), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (7), Old age, not falling within any other category (21) The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users who may be accommodated in the home at any one time is 21 No more than 7 service users aged 65 years and over with a mental disorder or dementia, excluding learning disability, may be accommodated at any one time 12th August 2008 Date of last inspection Brief Description of the Service: The Old Vicarage is a privately owned residential care home, which can accommodate twenty one older people. Seven people may also have dementia or a mental disorder. The home is registered to Equality Care Ltd and the registered manager is Mrs Gretta Mackenzie. The home is situated in the village of Staverton. This provides limited amenities, yet the County town of Trowbridge, is approximately two miles away. The home provides all single accommodation. All but three of the bedrooms are provided with en-suite facilities. Bedrooms are located on the ground and first floor. There are three stair lifts to access the various levels of the building. Communal areas consist of a lounge, conservatory and separate dining room. Staffing levels are maintained at four care staff on duty during the morning and three during the evening. At night there are two waking night staff and a member of staff provides sleeping in provision. The Old Vicarage (Staverton) DS0000057134.V377865.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. Before visiting The Old Vicarage, we sent the home an Annual Quality Assurance Assessment (AQAA) to complete. The AQAA is the home’s own assessment of how they are performing. The AQAA tells us about what has happened during the last year and about the home’s plans for the future. The AQAA was returned on time and fully completed. We sent surveys, for people to complete if they wanted to. We also sent the home surveys to be distributed to staff and health/social care professionals. This enabled us to get people’s views about their experiences of the home. We received surveys from eight people using the service. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home. This visit took place on the 27th November 2009 and the 2nd December 2009. Mrs Mackenzie was available throughout and received feedback at the end of the inspection. During our visit, we toured the accommodation and met with people in their own bedrooms and communal areas. We spoke to staff members on duty and observed the serving of lunch. We looked at care-planning information, staff training records and recruitment documentation. We also looked at documentation in relation to health and safety and complaints. The last key inspection of this service took place on the 12th August 2008. All key standards were assessed on this inspection. Observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: People are happy with the service they receive and feel able to raise any concerns which they may have. People have regular access to health care services and good relationships have been developed with professionals such as GPs and District Nurses. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.2 Page 6 Staff are aware of their responsibilities of reporting any allegation or suspicion of abuse. Robust recruitment procedures are in place to ensure all prospective staff are suitable to work with vulnerable people. Regular staff meetings are held and all staff are expected to attend so that they are kept up to date with information. Staff receive regular staff training so that they can develop their knowledge and skills on an ‘on going’ basis. What has improved since the last inspection? All assessment documentation has been reviewed and all assessments seen were detailed and reflected the person’s needs and the support they required. All care plans have been fully reviewed with a new system implemented. The plans are now detailed and person centred. The information clearly reflects people’s needs and the support they require. A system for regularly reviewing the information within care plans is now in place. People have their risk of developing a pressure sore assessed. Measures to minimise any potential risk are put in place and discussed with the relevant health care professional. People’s wishes in terms of resuscitation are now only identified within care plans if they have been specifically discussed and agreed with the person’s GP and family members. Care plans now contain information about medicines which are prescribed to be taken as required. Guidance which identifies when these medicines should be administered is in place. The medicine administration systems have been reviewed and as a result, only one member of staff completes each ‘drug round.’ This is safer practice and will minimise any risk of error. The medication administration record now shows when staff have assisted a person with the application of a topical cream. A copy of the Safeguarding Vulnerable Adults protocol is now available within the home for staff reference. The dining room has been redecorated with new carpet fitted. New lighting has been installed in an upstairs toilet. Covers have been fitted to radiators in the communal areas to ensure people’s safety. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.2 Page 7 An activity organiser is now in post and greater opportunities for social activities are available to people. Additional ancillary staff have been appointed to assist care staff with tasks such as serving drinks and meals. Additional bank staff have also been recruited which minimises the potential of needing to use agency staff. Potential risks such as carrying hot food on trays from the kitchen to the dining room have been risk assessed. Measures to minimise the risk have been implemented. Recommendations made at a recent environmental health inspection of the kitchen have been fully addressed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.2 Page 8 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 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 (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the admission process ensure that people’s needs are fully assessed and documented so an appropriate placement is assured. EVIDENCE: At the last inspection, we saw that people were being assessed before they were offered a placement at the home. However, the assessment documentation was limited in its detail and gave some conflicting information. We recommended that all assessments were sufficiently detailed to ensure people’s individual needs were clearly identified. In response to this, Mrs Mackenzie told us that all documentation used to record the assessment process had been reviewed. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 11 The AQAA confirmed this by stating ‘completely reviewed our assessment process. More structured paperwork, care plans, policies and procedures to ensure standards continue to remain high. Created a website with Resident input, which can provide additional information to prospective Residents and their relatives.’ There was a notice in the main entrance hall which said that the home’s Statement of Purpose was available in written format, large print or on compact disc. People were therefore able to have information about the home in a format which was easy for them to read and understand. The assessments we looked at were detailed and fully completed. They gave clear information about the person’s needs, their interests and particular likes and dislikes. A personal profile gave information about the person’s earlier life such as schooling, their occupation and their working and family life. The assessments were signed and dated and showed where the assessment had taken place. Mrs Mackenzie told us that an initial care plan was immediately devised after the assessment process had been completed. This enabled staff to have clear information about the person and the support they required before their admission. Staff told us that they were fully informed of people’s needs during handover and at staff meetings. Mrs Mackenzie told us that people’s needs were regularly assessed to ensure that the home remained suitable for them. Mrs Mackenzie said that two people were in the process of moving to other care services, as their needs could no longer be effectively met at The Old Vicarage. Within surveys, some people said that they had enough information about the home before moving in. Others could not remember. Those people we met during our inspection were not able to tell us about their admission to the home. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning has been improved upon which ensures staff have the information to meet people’s needs more effectively. People have good access to health care provision and have their medical needs met. Attention has been given to enable peoples rights to privacy, dignity and respect to be maintained. EVIDENCE: At the last inspection we made a requirement that all care plans must fully reflect people’s individual care needs and how they were to be met. In response to this, Mrs Mackenzie told us that all care plans had been rewritten. We saw that the format of the plan was more organised and all information was detailed and well written. The plans were much more person centred and reflected people’s individual needs, their preferred daily routines and their likes and dislikes. The care plans had been regularly reviewed and updated as people’s needs changed. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 13 Staff told us that the care plans were now much easier to use and had become a working document. They said they found it much easier to find key information. Mrs Mackenzie told us that people had benefited considerably from assisting with the development of their plan. She said further work would be undertaken as more information could always be added. The activity organiser told us that work was being done with people to complete their life histories. This information was then to be incorporated into people’s care plans. The care plans were kept in the office although were not securely stored. Mrs Mackenzie told us that due to the positioning of the office, there was always a staff presence so confidentiality of records was maintained. We advised that the care plans be either kept in a locked cupboard or a keypad could be installed on the office door. Mrs Mackenzie told us that this would be addressed during the planned refurbishment of the office. Within the AQAA it stated ‘all care plans have been rewritten. Care plans are individual to each Resident’s medical, mental and social needs, expectations, likes and dislikes. Care plans are easily accessible to staff. They form the structure of everything we provide for our Residents on a daily basis.’ We saw within the AQAA that staff had received training in person centred care and therefore ‘better person centred care practices’ had been introduced. The AQAA stated ‘staff are moving staff away from being ‘task orientated’ to ‘person centred’ in their approach.’ We saw during our visit that staff interactions with people were much improved. People told us that they were very happy with the care they received. One person said ‘I am very content here. They are all very good and help me when I can’t do things for myself.’ Another person said ‘you can’t fault them. I’ve got no complaints.’ People told us that they could see their GP if they needed to. One person said ‘Oh yes, you just ask one of the staff and they arrange it for you.’ Another person said ‘they know if you’re not too well and they would call the doctor for you.’ We saw from people’s care records that people have had medical support from District Nurses and GPs as required. Mrs Mackenzie told us that the home received good support from all health care personnel. Within the AQAA, it was stated that liaising with General Practitioners, Mental Health Team and District Nurses on how to improve on people’s care had been improved upon. The AQAA stated ‘the Home has become involved in the pilot of the My Home Life project. It is our aim to implement this throughout the Home. Care plans have been updated to include MCA [Mental Capacity Act] and Safeguarding Older Adults. Within surveys, each person said they ‘always’ received the care and support they needed. They said they ‘always’ received the medical care they required. Specific comments included ‘I am quite happy with what’s going on,’ ‘this is a The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 14 jolly nice place to be’ and ‘generally takes care of the people here.’ In relation to what the home does well, one person said ‘everything.’ Other comments were ‘I think it does everything well’ and ‘I think they offer all possible comforts and amenities.’ At the last inspection, we made a requirement to ensure that each person had their risk of developing a pressure sore assessed. We saw that this had been addressed. Mrs Mackenzie told us that some people had pressure relieving mattresses and cushions. We said that such equipment should be detailed within the person’s care plan. We saw that there were manual handling assessments in place. A new nutritional assessment had also been introduced. Mrs Mackenzie told us that following the last inspection, a review of medication administration had taken place. One staff member was now completing the ‘drug round’ rather than being supported by another staff member. We advised that the medication policy be updated to reflect this change. We saw that staff had signed the medication administration record appropriately when they had administered medication. Any handwritten medication instruction had been countersigned by another member of staff. Those people who managed their own medication had been assessed to ensure they had the ability to undertake the task safely. This was documented within the person’s care plan. Guidance in terms of medication to be taken ‘as required’ was also stated within people’s care plans. We saw that any medication with a short shelf life had been dated when opened. Mrs Mackenzie told us that the controlled drugs cabinet met current regulations on safe storage of medication. We saw that another cupboard which was used to store other medicines was not fit for purpose. Mrs Mackenzie told us that this was to be replaced during the office refurbishment. The service used a monitored dosage system to administer medication to people. The system did not show the days of the week so staff needed to carefully ensure that they were giving the right medication on the correct day. Mrs Mackenzie told us that she would speak to the pharmacist in order to try to make the system clearer and therefore safer. After the inspection, Mrs Mackenzie told us that she had spoken to the pharmacist and had been told it was not possible to change the system. The AQAA stated ‘all staff who dispense medication are thoroughly trained in house and also complete training packs provided by our pharmacist. Only staff deemed competent by the manager are allowed to dispense medication.’ Since the last inspection, there has been one medication error. This was reported to us and investigated by senior managers. Measures were put in place to minimise further errors. At the last inspection, some staff interactions did not promote people’s dignity. This included explaining to a person about the reasons for their medication at the dining room table whilst other people were around. This did not promote their privacy and dignity. Mrs Mackenzie told us that all medicines were now The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 15 being administered after people had finished their meal. This enabled people to have their meal without being interrupted. It also enabled people to take their medication discreetly. During our inspection, we did not see any incidents which compromised people’s well being. Staff were attentive and respectful in their interactions with people. We saw staff supporting some people with their mobility. While doing this, staff talked to the person and gave reassurance. We saw that staff knocked on bedroom doors and waited for an answer before entering. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to social activity provision so people now have more opportunities of things to do. Visitors are welcomed and people are supported to maintain important relationships. The food is of a good standard and enjoyed by people. EVIDENCE: At the last inspection, we recommended that a review of social activity provision be undertaken to ensure that people’s individual social needs were met. We saw within the AQAA that activity provision had been developed. The AQAA stated ‘activity co-ordinator has had his hours and budget increased. Introduced more varied and resident led activities. Introduction of Tai Chi. Relatives and residents becoming involved in planning activities, i.e. a resident has been reading poetry to the others. There is now a weekly activities sheet so that we plan activities in advance. Introduced an activities assessment tool which can help us plan and deliver activities on an individual basis, especially to those residents who have a degree of confusion or dementia.’ The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 17 People told us that they were quite happy with the range of social activity available within the home. One person said ‘there is usually something going on but you don’t have to join in.’ Another person told us ‘I like to come down to the lounge as you see people and can get involved with what ever is on.’ Staff told us that they felt social activity provision had developed significantly since the last inspection. They said the appointment of the activity coordinator had been paramount in enabling a planned, consistent programme of social activity provision. When we arrived at the home, some people were having breakfast. Others were being supported with their personal care routines. One staff member was playing cards with a person in the lounge. The activity coordinator was talking to people about issues in the newspaper. They then spent time with other people ensuring that they were well and did not have any concerns. Later in the day, a reading group took place. People engaged well and the discussion led to various other topics of every day life. The activity coordinator told us that his time was divided into providing a combination of group activities and one-to-one individual time with people. He told us that people were currently being supported to complete work on their life histories. He said that people were finding the exercise useful and were enjoying the one-to-one time to talk. The activity coordinator told us that other enjoyed activities were music sessions, card games and reminiscence. The notice board showed that the mobile library visited regularly. A pantomime with visiting entertainers and a New Year’s Eve party were also advertised. Mrs Mackenzie told us that the hairdresser visited on a weekly basis yet people could also use their own hairdresser, if they wanted to. In relation to social activities, the AQAA stated ‘trips to places of interest, local events and places requested by residents’ were things the home did well. The AQAA also stated ‘flower arranging organised with expert to demonstrate. The local clergy visit regularly to give Communion to the residents. The local PAWS funded by Wiltshire Council have provided a series of art and mosaic workshops with the residents.’ A member of staff told us that pet therapy had been introduced and appeared very productive for some people. Mrs Mackenzie told us that a high number of events had been organised for the festive period. She said that people using the service had been involved with planning the Christmas programme of events. Mrs Mackenzie told us that people could have a massage or be involved with Reike therapy or Tai Chi. Staff told us that two cats had been purchased and were to be introduced into the home shortly. There were photographs of the cats on the notice board. Some people attended the local ‘Sunday club’ within a nearby town. Mrs Mackenzie told us that one person often led a Bible Group. Various choirs had visited to provide entertainment for people. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 18 Within surveys, people told us that there were always activities which they could join in with. One person however, suggested ‘more ‘academic’ activities.’ Mrs Mackenzie told us that she would address this at the next ‘resident’s’ meeting. We were told that a computer had been purchased for people’s use. The AQAA stated ‘a few residents have e-mail accounts.’ It also stated that social activity was to be further developed. People were able to have visitors at any time of the day. Mrs Mackenzie told us that many relatives visited on a regular basis and also took their family member out for lunch or another such activity. Within a survey, in relation to what the home does well, one person told us ‘retains a good, relaxed atmosphere. Always courteous to visitors.’ People told us that they were very happy with the food they received. One person said ‘yes, we can’t complain, it’s always very nice and hot.’ Another person said ‘the food is very good here. We get a good selection. It’s cooked nicely and always looks good.’ Within surveys, people said they ‘usually’ liked the meals. One person, in relation to what the home could do better said ‘more input from residents about food.’ Mrs Mackenzie told us that meal provision was always discussed at each ‘resident’s’ meeting. She said she would however ensure that each person had the opportunity to give their view. At the last inspection, staff were carrying large trays of food such as dishes of soup from the kitchen to the dining room. This was a health and safety hazard, which needed to be risk assessed. We saw that this had been addressed. Staff were carrying smaller, covered containers on trays. People were supported to take their food from serving dishes on their table. We saw that gravy was placed in gravy boats so that people could help themselves. The meal looked colourful and appetising. Staff supported people well but then gave space to enable people to eat quietly. We saw that people were offered a glass of sherry before their meal. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that any concern they raise would be taken seriously and resolved as quickly as possible. Clear systems are in place to minimise the risk of people experiencing abuse. EVIDENCE: People told us that if they had a concern, they would speak to the manager or a member of staff. One person told us ‘we have regular meetings so if there was anything wrong you could tell them then.’ Another person said ‘I’ve never had any reason to complain but if I did, I’m sure they would listen and sort it out.’ We saw within the AQAA that a high level of complaints had been received since the last inspection. Mrs Mackenzie told us that she had tried to heighten people’s awareness of making a complaint however small the issue appeared to be. Each issue was then investigated, resolved and documented. Mrs Mackenzie told us that she felt it important that people could be honest and raise issues, so that the service could be improved upon. Mrs Mackenzie said she had an ‘open door ‘policy and felt that she had developed a good relationship with people using the service. She felt this enabled people to feel confident in raising concerns. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 20 We looked at the complaint log and saw that issues had been fully documented. The record showed whether each complaint had been upheld or not. It also showed what action had been taken and the action taken to minimise further occurrences. The AQAA stated ‘all staff are encouraged to record all complaints, however small, to promote the culture that all complaints are valid and should be treated with respect and seriously. All complaints acted upon without delay by Manager and Senior Staff with feedback to the resident/relative. All complaints are discussed at the weekly QA/managers meeting.’ Staff told us that they had completed training in adult protection. This had been undertaken in house. They were aware of what to do if they suspected or were told about an allegation or suspicion of abuse. Mrs Mackenzie told us that four members of staff had completed a vulnerable adult’s course at the local police station. She was planning to arrange this again so that more staff could attend. The AQAA stated that staff cover safeguarding as part of their National Vocational Qualification training (NVQ.) We saw that Wiltshire and Swindon’s safeguarding procedures, ‘No Secrets’ were readily accessible in the office for staff reference. Mrs Mackenzie told us that she had gained a full updated copy of the protocol following the last inspection. Since the last inspection, two incidents have been appropriately made to the local safeguarding procedures. No further action was required. Through discussion, it was evident that Mrs Mackenzie was fully aware of her responsibilities in terms of safeguarding. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While recent redecoration and some refurbishment have improved the environment, further work in other areas of the home would be of benefit. People have been safeguarded from the risks of hot surfaces through the installation of covers to all radiators. EVIDENCE: People’s bedrooms were located on the ground and first floors. The ground floor was split level with a series of steps from the lounge, dining and entrance hall area to some people’s bedrooms. There was a main staircase to the first floor, with a small landing half way up. At the last inspection, we noted that the toilet on this landing did not have curtains to the glass panels on the door. Mrs Mackenzie told us that this had been addressed. There were three stair lifts to enable people to negotiate the different levels of the home, if they needed assistance with their mobility. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 22 All but three of the bedrooms had en-suite facilities. We saw that people had personalised their rooms. Many contained people’s own furniture and a range of personal possessions such as pictures and ornaments. Communal areas consisted of a lounge, conservatory and a separate dining room. We saw that the conservatory roof was in need of some repair as it was leaking in one particular area. At the last inspection, we recommended that some redecoration and refurbishment would enhance the environment for people. In response to this, the porch, hallway, lounge and dining room were re-decorated. This had significantly improved the areas. There was new carpet in the hall and dining room and new furniture in the lounge. The AQAA confirmed that all new chairs had pressure relieving seats as standard. Mrs Mackenzie told us that people had chosen the colour schemes, finishes and furniture. She said that all empty rooms were re-decorated according to the new person’s personal preferences. While noting that some improvements had been made to the environment, we saw that some carpets in people’s bedrooms were in need of replacement. The carpet in the corridor was beginning to fray in places. This could be a trip hazard and therefore the area needed to be made safe with consideration then given to the carpet’s replacement. We saw that new flooring for the assisted bathrooms was planned. The AQAA stated that the garden had been landscaped and new furniture purchased. People using the service had been involved in giving their views about both aspects. At the last inspection, we made a requirement to ensure that potential risks from radiators be minimised through the installation of covers. The AQAA confirmed that specialist radiator covers had been fitted to all exposed radiators. We saw these within the communal areas. At the last inspection, people were also at risk of harm from some hot water outlets. We made a requirement that all hot water outlets be monitored to ensure the hot water was maintained at a safe temperature. We checked a number of outlets and the hot water temperature was satisfactory to the touch. There were records in place to show the monitoring of the temperatures. We advised that the frequency of the checks be increased. Following the inspection, Mrs Mackenzie told us that the maintenance person will now check outlets on a monthly basis. At the last inspection, we saw that the laundry room was not locked and therefore people using the service had unrestricted access to the room. Following the inspection, the laundry was risk assessed. The risks were considered low although would be reviewed in terms of people’s changing needs. We saw that substances such as fabric conditioner were stored unsecured in the room. We recommended that these be kept securely and/or a keypad be fitted to the door. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 23 We saw that the standard of cleanliness had improved since the last inspection. Within surveys people told us that the home was always fresh and clean. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels have been improved upon which enables staff to spend more time with people. People are protected by a robust recruitment procedure. People are supported by a motivated staff team who receive regular training to update their knowledge and skills. EVIDENCE: At the last inspection, some people said that staffing levels were insufficient. We made a requirement to review this and to ensure the numbers of care staff providing direct care to people were sufficient to meet people’s needs. In response to this, Mrs Mackenzie told us that staffing levels had been increased. The AQAA confirmed this by stating [improved] ‘increased staffing levels including care staff, new housekeeper and activities co-ordinator, volunteers and administration staff. We have formed a group of bank staff consisting of ancillary and care staff. General Assistants have been employed to assist care staff with breakfast, morning coffee, housekeeping and supper preparation/serving which frees up care staff.’ Mrs Mackenzie told us that there were four care staff on duty in the morning with either herself or the deputy manager also available. There were also housekeeping staff who completed tasks such as serving drinks. During the afternoon and evening there were three care staff and an evening cook. The The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 25 activity coordinator’s times of working were variable due to people’s needs and the needs of the service. They said they sometimes worked in the morning and at other times in the afternoon. Staff told us that the increase in staff had made a considerable difference. They said the activity coordinator post in particular had enabled them to provide more direct care to people whilst being assured that social activity was taking place. Mrs Mackenzie told us that she felt the staff were working well. She said they were motivated, enthusiastic and very keen to further develop their knowledge and skills. While the increase in staffing has taken place, some people within surveys told us that staffing levels could be improved upon. One person said ‘need more staff.’ Other comments were ‘due to staff shortages occasional delay in responding to aid call’ and ‘more attention to planning staff rotas in order to avert occasional staff shortages.’ Four people told us that staff were ‘always’ available when they needed them. Three people said that staff were ‘usually’ available. Mrs Mackenzie told us that there had been a period of staff sickness which was difficult to manage. However, with the increase in the level of bank staff, Mrs Mackenzie was confident that consistency within staffing would be maintained. People did not raise staffing levels as an issue of concern with us at this inspection. People told us that staff listened and acted on what they said. Specific comments were ‘they are very kind,’ ‘everybody is kind to you’ and ‘they are all very good, you couldn’t fault them.’ As stated earlier in this report, we saw that staff interacted well with people. They were light hearted and were attentive when supporting people. We looked at the recruitment documentation of three recently employed members of staff. The files contained the required information, which showed a robust recruitment procedure. There was a photograph, an application form and two written references. There were details of the person’s medical health, which ensured they were fit to do the job. Each staff member had been checked against the Protection of Vulnerable Adults register before commencing employment. Criminal Record Bureau (CRB) certificates were in place as required. These checks ensured the staff were suitable to work with vulnerable people. Within the AQAA we saw that NVQ Training and in-house training were areas the home did well. The AQAA stated that all staff had received training on the Mental Capacity Act and Promoting Independence. Mrs Mackenzie told us that the organisation employed a training assistant who attended the home once a week to support staff with their training needs. Staff told us that there was always training being arranged. One staff member told us about the ‘End of Life’ training she had recently completed. She said The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 26 this had been very useful and productive. Another staff member told us that they were up to date with all their mandatory training. They also told us about training in aggression and assertiveness which had been arranged. We saw that a high level of in house training was completed. Topics included infection control, fire drills and evacuation, dementia care and abuse in the care home. There had also been training sessions on death and dying, challenging behaviours and Swine Flu. Some training sessions involved a video and staff were then asked to complete questionnaires. Mrs Mackenzie told us that training by external training providers had also taken place. Such topics had included risks and outcomes focus care planning, leadership skills, therapeutic activities and diabetes training. Some staff attended a workshop in relation to Mental Health. We saw that staff had received training in the new medication system that had recently been introduced. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mrs Mackenzie has improved the service people receive and has plans for further development. The management of people’s personal monies is generally well maintained. People’s health and safety has been enhanced through the installation of radiator covers. EVIDENCE: Mrs Mackenzie has worked at the home for a number of years. She became the registered manager in April 2008. Mrs Mackenzie has NVQ level 4 in care and management. Since the last inspection, Mrs Mackenzie has significantly developed the home and has improved the systems in place. All requirements we identified at the last inspection have been addressed. Mrs Mackenzie told us that she was pleased with the development of the home although believed The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 28 there was more to be done. She saw development as an ongoing process. This was confirmed within the AQAA whereby it was stated ‘always seeking ways to improve ourselves and the daily running of the Home.’ Mrs Mackenzie told us that she undertook all training the staff team completed. This included ‘End of Life’ training and the ‘My Life’ project. Mr Mackenzie also attended fire risk assessment training which the Fire and Rescue Service had organised. In relation to what the home does well, the AQAA stated ‘open and supportive management within the Home. Small family business – supportive to all – very personal – not institutionalised.’ Mrs Mackenzie told us that the majority of her working time is not counted as part of the staffing roster. However, she does undertake some care shifts on a regular basis so that she can maintain relationships with people and observe care practice. Mrs Mackenzie told us that regular management and senior staff meetings are now held within the home. This includes meeting with other managers within the organisation to discuss key issues. General staff meetings also take place on a regular basis with an expectation that all staff will attend unless they are on annual leave or sick leave. Mrs Mackenzie told us that she felt full staff attendance was essential to ensure everyone was kept up to date with information. Mrs Mackenzie told us that a staff meeting had been arranged for that evening. Fire safety was going to be addressed. Since the last inspection, regular ‘resident meetings’ have been introduced. A record of each meeting was maintained. Within one meeting we saw that more trips out were to be encouraged with key workers. As part of the home’s quality assurance system, staff complete bedroom checks on a daily basis. This is to ensure that the environment is kept clean, tidy and well maintained. Mrs Mackenzie told us that weekly quality assurance meetings had also been introduced. We saw that surveys had been sent to people in order to get feedback about various aspects of the home. Mrs Mackenzie also said that people readily share their views on a daily basis. Any negative comments are looked into, addressed and documented within the complaints log. Some people had placed small amounts of their personal monies, for the home to hold safely. We looked at the systems for managing this and checked a sample of cash amounts. The cash corresponded with the balance sheets. Only senior staff had access to the storage of people’s personal monies. We saw that two members of staff signed to demonstrate each transaction. The systems were regularly audited. We saw that expenditures generally covered hairdressing and chiropody costs. We recommended that some people were asked to deposit money for safekeeping on a more regular basis. This was because some balance sheets showed a negative amount and therefore people were being subsidised until more money was deposited. This situation gave potential for error. Mrs Mackenzie told us that people’s family members had The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 29 been approached regarding more frequent deposits yet the situation had not as yet been resolved. We saw a range of environmental risk assessments were in place. Following the last inspection, risk assessments had been completed in relation to the laundry room and carrying hot food. Equipment such as the portable electrical appliances had been tested as required. A new accident book had been purchased which complied with Data Protection requirements. Mrs Mackenzie told us that she was now monitoring all accidents and assessing potential trends. As a result, staff now supported one person to go for a walk each afternoon. This had reduced the number of falls the person had experienced. The home had an Environmental Health inspection in November 2008. Mrs Mackenzie told us that all recommendations the environmental health officer had made, had been addressed. The fire log book showed that fire safety was generally well managed. The fire safety systems were only checked once in September although at all other times, the checks were consistently undertaken. Mrs Mackenzie told us that this was probably due to the maintenance person being on annual leave. She said she would make alternative arrangements for the checks to be done at these times. In response to recent fire training, Mrs Mackenzie told us that she was in the process of developing individual evacuation plans for people. Staff were up to date with their mandatory training in manual handling and first aid. Mrs Mackenzie told us that three staff had completed their training to become a manual handling trainer. This enabled staff to receive regular manual handling training updates so they were supporting people safely. As stated earlier in this report, people were now protected from hot surfaces through the installation of radiator covers. The temperature of the hot water had been monitored although we recommended that this was done more regularly. Following the inspection, Mrs Mackenzie told us that she had instructed the maintenance person to do this on a monthly basis. The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 30 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 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 3 X 3 X 3 X X 3 The Old Vicarage (Staverton) DS0000057134.V377865.R01.S.doc Version 5.3 Page 31 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 Refer to Standard OP7 OP8 OP9 OP19 OP19 OP19 OP26 Good Practice Recommendations All personal records should be securely stored. Pressure relieving equipment and other measures to minimise the risk of developing a pressure sore currently in place should be identified within the person’s care plan. The medication policy and procedure should be updated to reflect the changes in medication administration. Ongoing redecoration and refurbishment of the home should be undertaken. A review of the standard of all carpets should be undertaken. Any carpets which show staining or a health and safety risk should be replaced. The conservatory roof would benefit from repair in some places. While the accessibility of the laundry to people using the service has been risk assessed, all substances such as fabric conditioner should be safely stored. DS0000057134.V377865.R01.S.doc Version 5.3 Page 32 The Old Vicarage (Staverton) Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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