Care Home: The Victoria Residential Home

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What the care home does well The admission process included a thorough assessment of the residents` needs, prior to them moving into the home. This enabled the manager and prospective residents to determine whether or not their needs could be met within the home. All residents had a care plan based on their assessment of needs. The plans were easy to read and understand and provided guidance for staff on how to meet the residents` needs. The plans also incorporated important information about the residents` preferences and likes and dislikes. This gave the staff an insight into how the residents wished to be cared for. The daily routines were flexible and designed to meet the needs and wishes of the residents. The residents could follow personal routines and were encouraged to make decisions about their lives. Visitors were made welcome in the home and the residents were supported to maintain personal relationships. This enabled them to continue to play an active role in their family life. The majority of staff had achieved NVQ (National Vocational Qualification) level 2. This qualification provided the staff with the necessary knowledge for their role within the home. The residents had access to a clear complaints procedure and were aware of who to speak to in event of a concern. This meant that any worries could be quickly resolved. What has improved since the last inspection? Since the last inspection, the care plan format had been updated to include information about the residents` needs and preferences during the night. A personal preference checklist had also been completed to provide staff with details about their daily preferences and choices and there was written evidence to demonstrate that some relatives had been consulted during the care planning process. The residents on Butterworth unit had been consulted about their choice of underwear and footwear. This had ensured the residents were able to exercise choice and their dignity was promoted. The manager and the staff have worked hard on improving the medications management. These were seen to have significantly improved. Residents were now receiving their medications in a manner which maintained their safety and supported their individual needs. The staff had received some training on caring for people with a dementia. As a result, the residents were offered more opportunities to participate in activities and the staff had greater understanding about incorporating meaningful conversation as part of daily life and personal routines. A record of meals served had been maintained on both units, which provided evidence of the food eaten by the residents at the main meal times. Two corridors had been repainted and a development plan had been devised for the environment. Repairs had also been carried out to the hot water and heating system, to ensure there was an adequate supply of hot water and the heating was more reliable. The manager had completed NVQ level 5 Leadership and Management Award and had worked closely with us to ensure we had been notified of all significant events and incidents which had occurred in the home. This meant we were able to track the progress made to implement the improvements and we were assured the residents` well being was monitored. The responsible individual or his representative had completed a monthly report of their visits to the home. This demonstrated the responsible individual was monitoring the quality of the service provided and was aware of the standard of the premises and any problems or complaints. What the care home could do better: The residents` healthcare needs must be carefully monitored and recorded and action must be taken as appropriate. This is to ensure all healthcare needs are met. Risk assessments must be carried out in respect to behaviour, which challenges others and the service. The risk assessments must be supported by risk management strategies to ensure staff respond and manage any potential risks in a safe and consistent manner. A review must be carried out of the catering arrangements to ensure the residents are provided with suitable nutritious food, which is varied and properly prepared. The record of meals served must include suppers. This is to ensure that each resident`s diet can be monitored and it can be demonstrated that the residents are served a varied and wholesome diet. A record must be made of all action taken in response to a complaint. This is to ensure all complaints are appropriately investigated and resolved and any trends can be identified. The premises must be kept in a good state of repair externally and internally. This includes ensuring that windows operate properly at all times, in order to ensure the dignity, comfort and safety of the residents. In addition all areas of the home must be kept clean, to ensure the residents are provided with an hygienic environment. All recruitment records and checks must be collated in line with the current legislative requirements. This is to ensure staff are fully vetted prior to commencing work in the home. The registered person must establish and maintain a system for evaluating the quality of the services. This is to ensure the residents receive a good quality service and their best interests are safeguarded. The electrical installations and portable appliances must be tested to ensure they are safe. This is to avoid any unnecessary risks to health and safety of the residents. The registered person must consult with the Fire Authority to ensure appropriate fire drills are carried out at suitable intervals and the residents and the staff know what procedure to follow in the event of fire. In addition, environmental risk assessments must be carried out in respect of the corridor flooring and the use of the bath hoists. This to ensure potential risks are identified and as far as possible eliminated. Key inspection report Care homes for older people Name: Address: The Victoria Residential Home Thursby Road Burnley Lancashire BB10 3AU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie Playfer     Date: 0 9 0 6 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: The Victoria Residential Home Thursby Road Burnley Lancashire BB10 3AU 01282416475 01282441447 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Victoria Care Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. The maximum number of service users who can be accommodated is: 41. Date of last inspection Brief description of the care home The Victoria Residential Home is registered to provide accommodation and personal care for 23 Older People and 18 Older People with a Dementia. The home is a converted hospital with a spacious layout. It is located approximately 2 miles from Burnley town centre and there is a main bus route nearby. There are car-parking facilities at the front of the home and there is a public park directly opposite. Care Homes for Older People Page 4 of 34 Over 65 0 41 41 0 1 2 0 1 2 0 1 0 Brief description of the care home Accommodation is provided in 30 single bedrooms and 5 double bedrooms on three floors. There is a passenger lift linking the floors. Seventeen of the single bedrooms and one double room have ensuite facilities comprising of a toilet and wash hand basin. The home is split into three units and is staffed accordingly. The ground floor is known as the Thursby Unit and provides personal care for older people. The first floor provides personal care for older people who have a dementia and this part of the home is known as the Butterworth Unit. There were no residents accommodated on the second floor. At the time of the inspection (June 2010) the scale of charges ranged from £389.00 to £435.00. Additional charges were made for hairdressing, chiropody, dry cleaning, specialist toiletries and day trips. Information was made available to prospective residents in the form of a statement of purpose and service users guide. The service users guide was usually given to relatives and/or prospective residents on viewing the home or at the point of assessment. Previous inspection reports can be viewed in the home or downloaded free of charge from the Commissions website at www.cqc.org.uk Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection, which included a visit to the home was conducted at The Victoria Residential Home on 8th and 9th June 2010. The inspector was accompanied by a Pharmacy Inspector on the first day of the inspection and a Compliance Manager on the second day. We last visited the home on 29th March 2010 to carry out a random inspection and the last key inspection was carried out on 11th and 12th January 2010. Following the last key inspection, the manager submitted an improvement plan, which set out their planned action to meet the legal requirements set out in the inspection report and the timescales by which the requirements would be met. At the time of the visit there were 27 residents accommodated in the home. During the inspection we spent time with the residents, looked round the home, read some of the residents care records and other documents and talked to the staff, the manager and Care Homes for Older People Page 6 of 34 the responsible individuals representative. We also consulted our records about the service and information we have received over the last six months. As part of the inspection process we used case tracking as a means of gathering information. This process allows us to focus on a small group of residents living in the home, to assess the quality of the service provided. The pharmacy inspector carried out a detailed inspection of the management of medicines and her findings are included in the report in the Health and Personal Care section. Since the last inspection, the registered person was issued with a Statutory Requirement Notice in respect to the management of medicines. Whilst the home was found to be non compliant with this notice during the random inspection on 29th March 2010, all requirements of the Notice were found to be met during this key inspection. Prior to the inspection, the manager completed an Annual Quality Assurance Assessment known as AQAA. This is a detailed self assessment questionnaire covering all aspects of the management of the agency. This provided useful information and evidence for the inspection. Satisfaction questionnaires were sent to the home for distribution to the staff and residents. Four questionnaires were returned from the residents and five questionnaires were received from members of staff. We collated the responses and used them for evidence purposes throughout the inspection process. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? Since the last inspection, the care plan format had been updated to include information about the residents needs and preferences during the night. A personal preference checklist had also been completed to provide staff with details about their daily preferences and choices and there was written evidence to demonstrate that some relatives had been consulted during the care planning process. The residents on Butterworth unit had been consulted about their choice of underwear and footwear. This had ensured the residents were able to exercise choice and their dignity was promoted. The manager and the staff have worked hard on improving the medications management. These were seen to have significantly improved. Residents were now receiving their medications in a manner which maintained their safety and supported their individual needs. The staff had received some training on caring for people with a dementia. As a result, the residents were offered more opportunities to participate in activities and the staff had greater understanding about incorporating meaningful conversation as part of daily life and personal routines. A record of meals served had been maintained on both units, which provided evidence of the food eaten by the residents at the main meal times. Two corridors had been repainted and a development plan had been devised for the environment. Repairs had also been carried out to the hot water and heating system, Care Homes for Older People Page 8 of 34 to ensure there was an adequate supply of hot water and the heating was more reliable. The manager had completed NVQ level 5 Leadership and Management Award and had worked closely with us to ensure we had been notified of all significant events and incidents which had occurred in the home. This meant we were able to track the progress made to implement the improvements and we were assured the residents well being was monitored. The responsible individual or his representative had completed a monthly report of their visits to the home. This demonstrated the responsible individual was monitoring the quality of the service provided and was aware of the standard of the premises and any problems or complaints. What they could do better: The residents healthcare needs must be carefully monitored and recorded and action must be taken as appropriate. This is to ensure all healthcare needs are met. Risk assessments must be carried out in respect to behaviour, which challenges others and the service. The risk assessments must be supported by risk management strategies to ensure staff respond and manage any potential risks in a safe and consistent manner. A review must be carried out of the catering arrangements to ensure the residents are provided with suitable nutritious food, which is varied and properly prepared. The record of meals served must include suppers. This is to ensure that each residents diet can be monitored and it can be demonstrated that the residents are served a varied and wholesome diet. A record must be made of all action taken in response to a complaint. This is to ensure all complaints are appropriately investigated and resolved and any trends can be identified. The premises must be kept in a good state of repair externally and internally. This includes ensuring that windows operate properly at all times, in order to ensure the dignity, comfort and safety of the residents. In addition all areas of the home must be kept clean, to ensure the residents are provided with an hygienic environment. All recruitment records and checks must be collated in line with the current legislative requirements. This is to ensure staff are fully vetted prior to commencing work in the home. The registered person must establish and maintain a system for evaluating the quality of the services. This is to ensure the residents receive a good quality service and their best interests are safeguarded. The electrical installations and portable appliances must be tested to ensure they are safe. This is to avoid any unnecessary risks to health and safety of the residents. The registered person must consult with the Fire Authority to ensure appropriate fire drills are carried out at suitable intervals and the residents and the staff know what procedure to follow in the event of fire. In addition, environmental risk assessments must be carried out in respect of the corridor flooring and the use of the bath hoists. This to ensure potential risks are identified and as far as possible eliminated. Care Homes for Older People Page 9 of 34 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents had their needs properly assessed and they were provided with appropriate written information to enable them to make an informed choice about where to live. Evidence: Current and prospective residents were provided with written information in the form of a service users guide and a statement of purpose. Both documents met regulatory requirements and provided useful details about the service. The guide had been distributed to the current residents and a copy was available to view in each bedroom. The statement of purpose and the previous inspection report were accessible for reference purposes in the reception. This meant the residents had access to suitable and relevant information about the provision of care and support in the home. At the time of the inspection, the responsible individuals representative explained a new brochure was being developed along with a new website. Care Homes for Older People Page 12 of 34 Evidence: Privately funded residents had been issued with a contract and residents funded by the local authority had been provided with an individual service agreement. A copy of the contract was included in the service users guide. The contract was easy to read and was presented in a clear format. This meant that residents were aware of their rights and obligations and knew what they could expect from the service. There had been no new residents admitted to the home since the last inspection. However, there was an assessment tool available, which could be used by the manager to carry out an assessment of prospective residents needs. The personal files of three residents were looked at in detail as part of the case tracking process. Two of the residents were accommodated on Thursby unit and one resident was living on Butterworth unit. The records showed that a full assessment of needs had been carried out prior to admission by a member of the management team and where applicable by a social worker. Copies of the preadmission assessments seen covered a range of individual needs including personal, social, health and cultural needs. It was evident admissions were not made to the home in the absence of a full needs assessment, which meant the manager and staff had a good level of information about the needs of prospective residents before they moved into the home. Following the assessment of needs, a letter was sent to prospective residents and their families to confirm the persons needs could be met in the home. This meant residents were assured that the home was a suitable place for them to live. The manager confirmed that prospective residents were invited to spend as much time as they wished in the home prior to making the decision to move in. This enabled the person to meet other residents and staff and experience life in the home. Following admission, the contract stated that a trial period of eight weeks was offered to every new resident, so both parties could make sure the placement was successful and the residents individual needs could be met. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were cared for in a way that promoted their choice and dignity. However, risks were not always properly assessed, which meant there was the potential for inconsistency. Evidence: We looked closely at three residents files, as part of the case tracking process. From this we could see that all the files contained a care plan, which was based on the persons assessment of needs. Since the last inspection the care plan format had been updated to include information about the residents needs during the night. The care plans covered the residents social, cultural, physical and healthcare needs and included details about their preferred routines. Personal profile information had been incorporated into various sections of the care plan, to provide staff with facts about the residents past life experiences and current circumstances. Since the last inspection, a personal preference checklist had been added to the care plan documentation to provide staff with details about their daily preferences and preferred routines. Care Homes for Older People Page 14 of 34 Evidence: The care plans were supported by records of personal care, which provided information about changing needs and any recurring difficulties. The records had been made on a daily basis, to ensure staff were provided with ongoing details about the residents well being. Charts had also been maintained to record personal care and hygiene, however, these had not been consistently completed. The manager explained the charts were under review and as a result staff tended to record such details within the main care records. Written records seen on the residents files demonstrated that the care plans had been reviewed and updated each month. However, one residents plan had not been updated to reflect her religious needs, which meant staff may not have been aware of the importance of religion to this person. Since the last inspection, there was written evidence within the care plan documentation to demonstrate that some relatives had been consulted during the care planning process. The care plans included information about the residents healthcare needs, which meant the staff were provided with information about how best to monitor and respond to the residents medical conditions. Residents had access to health care services and all were registered with a GP. Specialist advice was sought as necessary from health care professionals, such as the District Nursing Team. Chiropody and Optician services visited the home and residents were provided with support to attend hospital and community appointments. However, one resident was concerned that she had not seen the chiropodist for sometime. This concern had been discussed with the staff, but had not been recorded in the plan nor had a chiropodist been contacted on her behalf. This situation was discussed with the manager who agreed to request a chiropody visit as soon as possible. Potential risks had been considered as part of the care planning systems. However, risk assessments and risk management strategies had not always been drawn up in order to manage any identified risks in a safe and consistent manner. For instance, there was no risk assessment seen in respect to managing one persons behaviour. Whilst charts had been maintained to record the persons behaviour there was no evaluation of the recorded information, which meant it was not possible to identify any patterns. This situation was discussed with the deputy manager, who later added some information to the care plan. The residents were generally complimentary about the staff for instance one resident said I like all the staff and another person said They are alright and they do their best to help. The staff demonstrated an awareness of treating the residents with respect and considering their dignity when providing care. The staff were observed to Care Homes for Older People Page 15 of 34 Evidence: interact with the residents in a friendly manner and they referred to the residents in their preferred form of address. The staff also encouraged personal choice and helped the residents continue with their preferred routines. Since the last inspection, the female residents on the Butterworth unit had been consulted about their choice of underwear and footwear. This had ensured that the residents were able to exercise choice and had been helped to wear appropriate underwear and footwear to promote their dignity. All residents who completed a questionnaire indicated they received the care and support they needed and staff were available when they required assistance. We looked at how medicines were handled, administered and recorded. To do this we spoke with the manager, staff and residents as well as looking at a sample of medication records and stock. Overall, significant improvements were noted in all areas of handling, recording and administering medication within the home. Medicines were stored securely to help prevent them being misused. Medication Administration Records were clear and appeared to be accurate, showing that medicines had been given to the residents correctly. Some residents chose to look after their own medicines and staff supported them to do this safely. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefited from flexible routines and increased participation in meaningful activities, however, the catering arrangements required further attention to ensure the residents received varied and nutritious meals. Evidence: The residents preferences in respect of social activities and daily living routines were considered and recorded as part of the assessment and care planning processes. There was evidence in the daily care records of residents going to bed and getting up at different times and this was observed in practice during our visit. The staff sought the residents views throughout the inspection and the residents spoken to felt comfortable to comment about life in the home. Individual records had been maintained of activities, entries had been made on a daily basis on the Thursby unit, however, whilst there were some gaps in the records on Butterworth unit, staff had recorded activities within the care records. Since the last inspection, the staff had received some training on caring for people with a dementia and there was an improved ethos on this unit. As such, we observed the level of interaction between the staff and residents had increased and staff had a greater understanding of how meaningful activities could be incorporated into the daily life of Care Homes for Older People Page 17 of 34 Evidence: the home. On the morning of the inspection, the residents enjoyed unstructured activities such as conversation, dancing and singing and in the afternoon were asked if they wished to participate in more structured past times such as dominoes. A senior member of staff had been designated the responsibility for activities and this had worked well. Since the last inspection, two specialist chairs had been obtained to allow two residents who required intensive pressure care to sit in the lounge and join other residents at mealtimes. This had made a considerable difference to the residents quality of life and well being. The residents were supported to continue with their chosen form of religious worship. A representative from the Roman Catholic Church visited the residents on a regular basis for prayers and communion. The residents had the opportunity to develop and maintain important personal and family relationships. There were no restrictions placed on visiting times and residents were able to receive their guests in private, should they wish to do so. The residents said the food was OK and Alright. Since the last inspection a record of meals served had been maintained on both units, however, this did not include the food served for supper. Staff on both units had concerns about the food served and the availability of food particularly at weekends and in the evenings. These matters were discussed with the manager during a senior staff meeting held during the visit. The residents had a choice of food each meal time and the menu for the day was displayed on a white board outside the dining room on each unit. The meal served at lunchtime was presentable and appetising, however, some aspects the tea time meal looked unappealing, which left the residents with a very limited choice. Food had been left unlabelled in the fridge and staff were therefore unaware of what had been prepared for residents on a diabetic diet. These observations were discussed with the manager and the responsible individuals representative and it was agreed an urgent review of catering would be carried out, in order to improve the situation. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents had access to a clear complaints procedure. However, not all complaints had been recorded in the complaints record, which meant it was not possible to determine any action taken. Evidence: The complaints procedure was included in the statement of purpose and the service users guide. It was also clearly displayed in each bedroom. The procedure contained the necessary information should a resident or their representative wish to raise a concern. Some of the residents spoken to said they could speak to a member of staff if they had a problem. Since the last inspection, the manager had spent time with a resident, who had previously expressed some concern about the service. His issues had been recorded in his care records, but not in the complaints record. This meant it was difficult to determine the type of investigation carried out and any subsequent action. According to records held by the Commission, there had been one complaint and one safeguarding alert made about the service since the last key inspection in January 2010. The issues raised in the complaint had been investigated under the homes internal procedure and details of the outcome had been sent to the Commission. The safeguarding alert was being coordinated by the Local Social Services Department and was not resolved at the time of the inspection. Care Homes for Older People Page 19 of 34 Evidence: Policies and procedures were in place in respect to safeguarding vulnerable adults along with a copy of Lancashire County Councils Multi Agency Policy and Procedure. This documentation set out the appropriate response in the event of any allegations, evidence or suspicion of harm or neglect. The internal procedures were placed on each unit for ease of staff reference. The staff confirmed they were familiar with the safeguarding procedures and had discussed the process with the manager. The majority of the staff had received specific training in safeguarding vulnerable adults and discussion of the procedure was included in induction training. Staff also had access to a whistle blowing procedure, which set out the procedure for reporting bad practice. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst some aspects of the environment had the potential to compromise the residents dignity, safety and comfort, a development plan had been devised to address these issues. Evidence: The Victoria Residential Home is a converted hospital with a spacious layout. Accommodation is provided on three floors in 30 single bedrooms and 5 double rooms. Seventeen of the single rooms and one double room have an ensuite facility comprising of a toilet and hand wash basin. A large passenger lift provides access to all floors. Communal space is provided in lounges and dining rooms on each floor. All rooms provided sufficient space for the pursuit of recreational activities and the entertainment of visitors. We noted from our tour of the premises that residents had personalised their rooms with their own belongings, which included photographs, ornaments, furniture and televisions. Since the last inspection, two corridors had been repainted and an environmental development plan had been devised, which was sent to us following the inspection. Repairs had also been carried out to the hot water and heating system, to ensure there was an adequate supply of hot water and the heating was more reliable. The Care Homes for Older People Page 21 of 34 Evidence: water temperatures had been checked, but a record had not been made of which outlet had been tested. This is important because all water outlets had been fitted with preset valves and therefore would emit water at a different temperature. We observed repairs had not been carried out to all windows, as a result the windows in two bedrooms on Thursby unit did not open and the windows in one bedroom did not close. This meant the occupants of these rooms were not able to regulate the temperature and one resident was using an electric fan due to the warm weather. Whilst the hoist had been moved on Butterworth unit, there was limited space for the staff to operate the hoist and appropriately assist the residents. The hoist also had fixed arms, making it difficult for some residents to use the equipment and the seat presented the risk of entrapment. We noted that the difficulties in using the bathing equipment and the ergonomics of the bathrooms had been recognised in the environmental development plan and action was planned to resolve this situation. The standard of cleanliness was generally satisfactory throughout the home. However, some surfaces were dusty, particularly on Thursby unit and the fridge in the kitchen was unclean. The manager explained that an additional person had recently been employed for domestic duties and new cleaning schedules were being implemented. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were supported by a staff team who knew them well, however, the recruitment procedure was not sufficiently robust to fully protect the residents. Evidence: A staff duty roster was drawn up in advance and provided a record of the number of hours worked by the staff in the home. The roster indicated there were usually three staff working on Butterworth unit and three staff on the Thursby unit. There were two care staff on waking watch duty on each floor. Additional staff were employed to carry out domestic tasks such as cooking and cleaning. A recruitment and selection procedure was available; however, the procedure did not cover all the elements listed in the Regulations. This is important to ensure that all legal requirements are considered during the recruitment process. The files of five members of staff who had been employed within the last six months were looked at in detail. From this we could see each applicant had completed an application form and had attended the home for a face to face interview. However, we noted none of the applicants had completed a medical form, one person had been employed prior to the receipt of two references and a full CRB check and another person had not provided a full working history. This meant the staff had not been thoroughly checked prior to them commencing work in the home. Care Homes for Older People Page 23 of 34 Evidence: Arrangements were in place for care staff to undertake an in house induction programme and they were encouraged to apply for NVQ training. However, we noted from the induction records that one member of staff had not completed some elements of health and safety training and the induction training file referred to another home and was therefore not specific to The Victoria Residential Home. According to information supplied at the time of the inspection, 17 out of 27 staff had achieved NVQ level 2 or above. This equated to 63 of the overall staff team. In addition, 10 members of staff were working towards this qualification. This meant the majority of the staff team had achieved the necessary qualifications to enable them to carry out their role effectively. All staff who completed a questionnaire indicated they received training relevant to their role and they were kept up to date with new ways of working. Many of the staff had worked in the home for sometime and knew the residents well. Staff were given the opportunity to attend training courses in line with the needs of the residents. An overall training plan demonstrated that staff had received recent training on managing challenging behaviour and caring for people with a dementia. However, very few of the staff had received training on food hygiene and only a small number of staff had completed a first aid course. This is further discussed in the Management and Administration section. The home was linked via computer to the LWDP (Lancashire Workforce Development Partnership). This organisation operates an internet based staff training record and plan and provides access to training courses. The system displayed a training record for each member of staff and highlighted when mandatory training was due. This meant the manager could use this tool to plan future training. Care Homes for Older People Page 24 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the residents were consulted about their experience of living in the home, the quality assurance and health and safety systems required development in order to fully monitor the service and protect the residents. Evidence: The manager had been in post since September 2009. She was a Registered General Nurse and had a Degree in Health and Social Care and a Certificate in Management. She had also recently completed NVQ 5 Leadership and Management Award. The manager had many years experience caring for older people in both health and social care settings. She confirmed her intention to register with the Commission, however, this process had not commenced at the time of the visit. Since the last inspection, the manager had been proactive in updating us of progress made to improve the home. Further to this, the responsible individual had recently engaged two care home consultants to work alongside the manager in the future development of the service. There was a programme in place for staff supervision and the issues discussed during Care Homes for Older People Page 25 of 34 Evidence: the meetings were recorded on a suitable format. In addition to staff supervision, senior staff attended regular meetings with the manager. The care staff had also been given the opportunity to attend meetings, which gave them the chance to discuss forthcoming developments and ongoing changes. According to the manager the service had been awarded a post recognition Investors in People Award in October 2007 and had preferred provider status with the Local Authority. Satisfaction questionnaires had been distributed to the residents in March 2010 and whilst the results had been collated, feedback had not been given to the residents. The manager had carried out some audits, for example an analysis of falls and the management of medication. However, whilst the manager had fully completed an AQAA questionnaire, there was no action or development plan seen relating to the outcomes of the quality assurance systems. This meant it was difficult to determine the planned areas of development and how the service was going to be improved over the forthcoming year in line with positive outcomes for the residents. Residents meetings were held on both units at approximately six week intervals. The meetings gave the residents the opportunity to discuss their views about daily life in the home, such as the meals and activities. Appropriate arrangements were in place for handling money, which had been deposited with the home by or on behalf of a resident. A random check of the records of monies held on the premises was found to be correct. Since the last inspection, the responsible individual or a representative had completed a monthly report of their visits to the home. This demonstrated the responsible individual was monitoring the quality of the service provided and was aware of the standard of the premises and any problems or complaints. There was a set of health and safety procedures, in the main policy and procedure file. Staff had received health and safety training, which included moving and handling, food hygiene, first aid, fire safety and infection control. However, as mentioned previously few staff had received food hygiene or first aid training. This meant the staff may not have been aware of current food hygiene standards and there was not always a member of staff on duty who was first aid trained. Documentation seen during the inspection indicated the electrical safety certificate and the portable appliance certificate had recently expired. The fire log demonstrated that the staff had received instructions about the fire procedures during their induction and as part of mandatory training. However, whilst the fire alarm was tested on a weekly Care Homes for Older People Page 26 of 34 Evidence: basis, the manager had not carried out any fire drills. These are important so the residents and the staff know how to respond in the event of a fire. The manager had devised some risk assessments, in order to identify and manage any potential hazards in the internal and external environment. However, there were no risk assessments seen in respect of the corridor floors or the use of the bathroom hoists. Arrangements were in place to record accidents and incidents in the home. This ensured that the residents condition was closely monitored following an accident or incident. The Commission had been notified of significant events and incidents in the home. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 15 All risk assessments must include risk management strategies. Where intervention or treatment is identified, staff must carry out instructions in a consistent manner. This is to ensure unnecessary risks to health and safety of residents are so far as possible eliminated. 30/07/2010 2 19 23 The premises must be kept in a good state of repair externally and internally. This includes ensuring that windows operate properly at all times. In order to ensure the dignity, comfort and safety of the residents. 30/07/2010 Care Homes for Older People Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 15 The residents healthcare needs must be carefully monitored and recorded and action must be taken as appropriate. This is to ensure all healthcare needs are met. 30/07/2010 2 8 13 Risk assessments must be carried out in respect to behaviour, which challenges others and the service. The risk assessments must be supported by risk management strategies. This is to ensure staff respond and manage any potential risks in a safe and consistent manner. 30/07/2010 3 15 17 A record of meals served 16/07/2010 must be maintained for all residents living in the home, the record must include suppers. This is to ensure that each Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action residents diet can be monitored and it can be demonstrated that the residents are served a varied and nutritious diet. 4 15 16 The residents must be provided with adequate quantities, suitable, wholesome nutritious food which is varied and properly prepared. This is to ensure the residents receive a good quality diet. 5 16 17 A record must be made of all 16/07/2010 action taken in response to a complaint. This is to ensure all complaints are appropriately investigated and resolved. The premises must be kept in a good state of repair externally and internally. This includes ensuring that windows operate properly at all times, in order to ensure the dignity, comfort and safety of the residents. 7 26 23 All areas of the must be kept 16/07/2010 clean. This is to ensure the residents are provided with a hygienic environment. 30/07/2010 16/07/2010 6 19 23 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 8 29 19 All recruitment records and checks must be collated in line with the current Regulations. This is to ensure staff are fully vetted prior to commencing work in the home. 16/07/2010 9 33 24 The registered person must 18/08/2010 establish and maintain a system for evaluating the quality of the services. This is to ensure the residents receive a good quality service and their best interests are safeguarded. The registered person must consult with the Fire Authority. This is to ensure appropriate fire drills are carried out at suitable intervals and the residents and the staff know what procedure to follow in the event of fire. 16/07/2010 10 38 23 11 38 13 The electrical installations and portable appliances must be tested to ensure they are safe. This is to avoid any unnecessary risks to health and safety of the residents. 16/07/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 12 38 13 Environmental risk 16/07/2010 assessments must be carried out in respect of the corridor flooring and the use of the bath hoist. This to ensure any unnecessary risks are identified and as far as possible eliminated. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should be updated to reflect the residents religious needs. This is to ensure staff are aware of the importance of the residents religious beliefs. All complaints should be recorded in the complaints records. This will enable the manager to track complaints and address any emerging themes. An assessment of the bathroom facilities should be undertaken by a suitably qualified person for example an occupational therapist, to ensure the equipment is suitable to meet the needs of the residents. The recruitment and selection procedure should be updated in accordance with the requirements set out in the Regulations. This is to ensure all such legal requirements are considered during the recruitment of new staff. The induction training pack should be specific to the home and all staff should complete all elements of the induction training when they start work in the home. This is to ensure staff fully understand the management of health and safety in the home. Staff should receive food hygiene and first aid training. The registered person should ensure a qualified first aider is on duty at all times. This to safeguard the health and safety of Page 32 of 34 2 16 3 22 4 29 5 30 6 38 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations the residents. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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