Care Home: The Villa Nursing And Residential Home

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What the care home does well The service has demonstrated that it now has more strengths than areas for improvement. There are no significant areas for improvement relating to the health and safety of people using the service or issues of poor management. Where weaknesses emerge the service recognises and manages them well. Personal support is responsive to the varied and individual needs and preferences of the people accommodated. The delivery of personal and emotional support is individual and flexible. Staff respect privacy and dignity and are sensitive to changing behaviours. The service listens and responds to individuals` choices and decisions about who delivers their personal care. A relative, when asked the question, what do you think the agency does well? responded, `looks after people who in old age need constant nursing care and personal care with great comfort to my relative and surely to others`. What has improved since the last inspection? CARE HOMES FOR OLDER PEOPLE The Villa Nursing And Residential Home Park Avenue, Maddocks Madeley Telford Shropshire TF7 5AE Lead Inspector Pat Scott Unannounced Inspection 09:00 29th January 2008 and 7 February 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Villa Nursing And Residential Home Address Park Avenue, Maddocks Madeley Telford Shropshire TF7 5AE 01952 581022 01952 582431 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) Mrs Susan Juru Mr Douglas Juru vacant post Care Home 33 Category(ies) of Dementia (26), Mental disorder, excluding registration, with number learning disability or dementia (7) of places The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate a maximum of 33 service users. Within this 33, a) the maximum requiring nursing care shall not exceed 26 of whom 22 may be older people with dementia requiring nursing care. b) 7 may be younger adults with a mental disorder requiring nursing care. c) the remainder may be older people with dementia not requiring nursing care. The minumum staffing requirements are as follows:08.00 - 14.00 14.00 - 20.00 20.00 08.00 1 Qualified Nurse 1 Qualified Nurse 1 Qualified Nurse (RGN, EN or RMN) (RGN, EN or RMN) (RGN, EN or RMN) 5 Care Assistants 4 Care Assistants 3 Care Assistants 4th July 2007 3. Date of last inspection Brief Description of the Service: The Villa is a care home, which provides both personal and nursing care in single and double accommodation for older people as well as younger people with mental health needs. Owned and managed by Mr and Mrs Juru, The Villa is situated in Madeley, a long established Shropshire town, situated above Ironbridge Gorge, and now part of the Telford conurbation. Opportunities for shopping and recreational activities are to be found within walking distance and in Telford Town Centre, which is reached via a frequent bus service. The Villa is set in its own grounds and comprises of an original 19th century house, which has been added to by more recent extensions. It has several communal areas, including a large lounge/diner, a separate dining room, and two other lounge areas, one being located in the in the nursing wing. These are all on the ground floor. A ‘quiet’ sitting area is also available on the first floor. In addition to this, two outside patio areas with good access are furnished with quality garden furniture for residents to use if they choose to. The owners of The Villa make their services known to prospective service users The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 5 in their statement of purpose, and its brochure/service user guide. The current fees charged vary between £349 and £520 per week depending on the care, support and accommodation required. The only additional charges to service users are for hairdressing, toiletries and newspapers. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is * two star good service. This means the people who use this service experience good quality outcomes. A range of evidence was used to make judgements about this service. This includes: information from the provider in their improvement plans, staff records kept in the home, outcomes following a pharmacist inspection 7/2/08, discussion (where able) with people who use the service and surveys completed by their relatives, discussions with the staff team, discussion with the owner/manager, tour of the premises, planned quality assurance processes and observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? The owners are working towards introducing systems, to address shortfalls to meet the Regulations at previous inspections, so that the outcomes for service users in all areas of care are improved. In particular, the service has made plans to deliver significant change in care planning, training and clarifying staff roles and responsibilities. The owners are liaising closely with service users and their families in meetings to discuss change and the effect it will have on the service the home provides. These areas are being managed sensitively with due regard to service user involvement. A significant improvement has been made in recording within the care plans regarding health care. Service users and their families are treated as The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 7 individuals and with dignity and respect. Overall the management of the medicines of people who use the service has improved and is being carried out well, with most of the medicines being administered as instructed by their doctor. A small number of issues were identified but the pharmacist inspector now has the confidence that these will be addressed by the home. The standard of décor and furniture and fixings is also set to improve. This, together with the commitment to an on going maintenance regime will improved the health and safety for service users and staff. Relative comments welcome the changes and felt that staff were very attentive to individual needs. They also welcome the chance to be involved in the home and like to know what is going on. The home is managed in a way that shows it has the interests of the people using the service at the centre of what they do. Individuals living in the home say that they are satisfied with the service, feel safe and well supported. Through improvements in training all staff working at the service understand the importance of taking the views of residents seriously, and of listening to, and responding to, raised issues. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 8 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 Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standard 3. Key Standard 6 does not apply to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written records for the admission of new people to the service demonstrate that the process is personalised and that consideration has been given to all aspects of care. EVIDENCE: Discussion with the owner established the intention of the service to maintain improved pre-admission and admission records. The assessment information informs the care plan based on the individuals needs. There have not been any recent admissions. However, the service has introduced mental capacity assessments for areas where restraint may be used i.e. chemical restraint via medication. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 10 The manager keeps copies of the assessment summary and care plans of those carried out through care management arrangements. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service aims to address and meet assessed need through the continued development of plans of care, so that service users are provided with more person centre care. Service users’ care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully met. The manager understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that service users health matters are safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care plans seen at the last Random Inspection detailed basic information with not enough direction to staff on how they are to deliver some types of care e.g. wound care. Following consultation and review by the tissue viability nurse, new care plan documentation is in place which addresses shortfalls in previous records. The recording of clinical interventions in care has improved. Service users’ plans detail agreement, following assessments for capacity, for taking their medication e.g. to take with a drink or food. The owner stated that the introduction of the person centred plan will provide staff with a clearer picture of the person’s needs and progress and the impact of such care on their lifestyle and quality of life. This, at present, is a work in progress. Care plans had been recently reviewed with assistance from Shropshire Partners in Care. Medicines are being stored at the appropriate temperatures and in a safe and orderly fashion. The receipt, administration and disposal of Controlled Drugs are being carried out appropriately and the records are robust enough to evidence this. The records in the main show that service users are receiving their medication as prescribed. Risk assessments documented showed that safety issues are addressed whilst not impinging too much on the freedom of the individual to take risk. A comment received stated that they were impressed with the emphasis on allowing people to carry out their lifestyle choice to the best of their ability, whilst being mindful of their safety. Daily records monitor the progress of individuals and provide clear indications of how a person has spent their day. There is evidence that service users are involved in their care as comments are recorded in the regular reviews that take place. Care plans are consistently reviewed monthly. Service users all appeared reasonably groomed with their hair, nails and clothes looking clean. No issues were identified regarding approach of staff or being assisted with intimate tasks. A relative informed us through the survey that he considers the communication between himself and staff to be good. He stated that he is regularly consulted about changes to care and that staff discuss with him the options available in the management of his relative. Another also stated: ‘staff are very vigilant towards any symptoms or changes in her behaviour and frequently call a doctor for her’, and ‘mum always looks well cared for.’ The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides opportunities for service users to develop their social and communication skills. People living at the home are involved in daytime activities of their own choice and according to their interests and capabilities. Service users receive a healthy diet according to their assessed requirement and preference. EVIDENCE: Menus seen are nutritionally balanced and food and drinks are readily available. There is a choice and a relative comment was “meals are really wholesome.” An inspection by Environmental Health was taking place which did not identify any issues. The assessment process demonstrates that social/leisure pursuits have been addressed prior to admission in a personalised way for the individual. Once living at the home, social activities are provided and the service shows that this is based on service user consultation through monthly service user The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 14 meetings regarding all aspects of living at The Villa. Planned activities are displayed around the home. Relatives are enabled to keep in contact as one commented:’ as I live very far away I appreciate being able to telephone at any time to speak to my relative’. Another said:’ my aunt wont do anything or mix with others and they don’t force her to.’ A care worker is responsible for arranging activities who, together with the owner, is attending ‘be active’ training. Service users are enabled to go out into the community and several service users had been escorted to the local shops. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure which is accessible so that people who use the service know how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. EVIDENCE: Service user care is reviewed regularly with the placing authority. Action plans are in place to address any communication difficulties with families. Adult protection procedures have been implemented to seek resolution in complex cases of care. A suggestion box is in the foyer. All staff have received adult protection training. There is a good level of accessibility to the management at this home which ensures that concerns can be dealt with very quickly. A relative comment concluded: ‘I am in frequent contact with Mrs Juru and would hope to be able to find solutions directly with the owners if any problems were to arise’. A visiting professional stated: ‘when myself or other workers have raised concerns, a discussion of these issues has taken place, and a plan The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 16 agreed to move forward. There has always been a willingness to review concerns raised’. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home is set to improve, through service user choice, so that they live in a safer, better-maintained and comfortable environment, which encourages independence. EVIDENCE: The owner spoke of the refurbishment improvement plan, which is in place, and of the further long-term work to be in progress. All areas seen around the home are clean and rooms personalised according to the wishes of those service users occupying them. The choice and style of furnishings is conducted in consultation with service users and one service user has funded an alternative to the standard style on offer. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 18 The laundry rooms have appropriate equipment and washable surfaces. Sluice rooms have ceramic slop hopper type equipment which does not minimise the risk of cross contamination associated with disinfecting items by hand. Sluice rooms do not have a separate hand wash sink, the lack of which invites staff to wash their hands at the sluice hopper taps. Staff wear protective aprons and gloves when dealing with personal care. External grounds have been spruced up and provide comfortable seating areas. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are being trained and are in sufficient numbers to fulfil the aims of the home and meet the changing needs of service users. EVIDENCE: The service users know the staff very well and observation showed that they provide a personal but professional service. A relative stated that she liked the way staff talked to her aunt, they seem to care. Recruitment is in progress. One new member of staff was on duty and being shadowed by an experienced member of staff. Another new person had been working for 2 months and confirmed induction is in place. No issues were identified by staff. Induction packages are in place. Care staff do the laundry washing by day and ironing by night. Staff files of the two recent recruits had all checks in place with a checklist record for the recruitment process. Staff have regular meetings the last being on 31/1/08 and all discussions are minuted. A staff training file sampled contained up to date certificates in adult protection, fire, infection control and dementia training. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 20 A training matrix is in place which indicates that mandatory and other training is well under way. Four staff are starting NVQ 2 training. All staff have had adult protection training. All qualified nurses are having pressure ulcer care updates. The service has sought the advice of health care professionals in tissue viability, medication and care plans. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and with effective quality assurance systems and audits being developed, service users are assured that the overall conduct of the home is being well managed. EVIDENCE: The manager’s practice is service user focussed and shows a commitment to conducting regular service user meetings that are minuted. The owner’s plan is to provide total supernumerary management time and any direct care work will be in addition to staff on the rota for clinical and care The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 22 supervisory purposes. She is attending a leadership course to enhance her managerial skills. The service has developed a quality assurance programme consisting of audits, surveys etc which is being implemented. A service user survey was carried out in December 2007 with results being collated. Record keeping has improved as a result of the new formats implemented. A health and safety audit has been commissioned from an external provider. The service is accredited in investors in people following a re-assessment 25/1/08. Service users are enabled to manage their own bank accounts and the home maintains records of personal monies held. Details of financial management are kept in the care plans. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 23 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 2 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 Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 Regulation 23(1)(K) Requirement Timescale for action 31/08/08 2 OP26 23(1)(j) The provider must install a thermostatic sluice disinfector. This is in order to minimise cross contamination associated with disinfecting utensils by hand and to provide service users and staff with improved health and safety. The provider must install a 30/06/08 separate handwash basin in the sluice room to improve infection control practice. Staff must not use the taps on the sluice hopper. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP27 Good Practice Recommendations Care staff should only be involved in direct care duties. The owners should provide some dedicated laundry hours which would allow staff to concentrate on their care duties. The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 25 The Villa Nursing And Residential Home DS0000022281.V358629.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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