Care Home: Vale Court Care Home

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What the care home does well During our visit we spent a lot of time talking with residents and their visiting relatives. The general feeling was that they were very happy with the care provided and that things had improved considerably with the arrival of the new deputy manager and then the new manager. One person said `the staff are fantastic` and another said `staff are lovely could not wish for better, treat you like a human being, always treat you with respect, I like this, they do not make you feel you are a trouble`. Residents` medicines are stored safely and the records indicated that people always receive the medicines that have been prescribed by their doctor. People have choices about how they spend their time and a variety of different social activities are provided for those who like to join in. The records we looked at showed that complaints made to the home have been fully investigated and responded to. The building is light, bright and spacious and provides a comfortable, clean and wellmaintained environment for people to live in. The gardens have been improved and are accessible for people who use a wheelchair. Whilst it is early days yet, we received very positive comments about the new management team from the members of staff, residents and visitors who we spoke with during our visit. Several people told us that morale in the home had been poor but has now improved considerably. People we spoke to during our visit said that staff numbers were now being maintained and the deputy manager had brought much better organisation to work routines on the first floor. They also appreciated the home manager spending time on the `shop floor` each day. The home`s administrator is well established and residents and/or their relatives can discuss finances with her. There is a system for residents to be able to put small amounts of personal spending money in safe keeping. Detailed individual records are kept. What has improved since the last inspection? No requirements or recommendations were made at our last inspection, which was in May 2007. Improvements have been made to the environment both inside and outside. The gardens have been landscaped. The lounge and the dining room on the ground floor have been fully refurbished. What the care home could do better: The pre-admission assessments of new residents should be more detailed so that when someone comes to live at the home there is as much information as possible for the staff who will be providing care for them.There is room for improvement in the writing of care plans so that they give a more consistent standard of information across the home and staff can be aware of people`s needs and choices. More of the care staff should be given the opportunity to achieve a national vocational qualification in care to ensure that there is a well qualified staff team. Regular fire drills must be carried out so that all staff have the opportunity to attend fire drills and they know what to do in case of a fire. A record of the names of the staff attending should be kept so that the manager can see who has attended fire drills. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Vale Court Care Home 9b Chester Road Whitby Ellesmere Port Wirral CH65 9BD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Smith     Date: 0 8 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Vale Court Care Home 9b Chester Road Whitby Ellesmere Port Wirral CH65 9BD 01513564827 01513564280 vale.court@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Four Seasons (No 3) Limited care home 56 Number of places (if applicable): Under 65 Over 65 56 0 old age, not falling within any other category physical disability Additional conditions: 0 56 The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Physical Disability - Code PD. The maximum number of service users who can be accommodated is: 56. Date of last inspection Brief description of the care home Vale Court is a modern purpose-built two-storey nursing home situated in the Whitby area of Ellesmere Port close to the town centre. It is set in its own grounds behind local shops. There is easy access to local amenities and the home is convenient for public transport. The home provides care for older people and for younger adults with a physical disability. It is part of the Four Seasons group of care homes. Care Homes for Older People Page 4 of 25 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: two star good 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: The quality rating for this service is two stars. This means that the people who use this service experience good quality outcomes. Two inspectors visited Vale Court unannounced on 8 July 2009 as part of this inspection. During the visit we spoke with residents, staff and visitors. We walked round the building to see all the communal areas and some of the bedrooms. We checked records kept at the home and spent time talking with the manager and the regional manager. We also looked at any information that we had received about Vale Court since our last inspection there. Before the inspection the manager was asked to complete a Care Homes for Older People Page 5 of 25 questionnaire to give us up to date information about the service and survey forms were sent out for staff to give us their views. What the care home does well: What has improved since the last inspection? What they could do better: The pre-admission assessments of new residents should be more detailed so that when someone comes to live at the home there is as much information as possible for the staff who will be providing care for them. Care Homes for Older People Page 7 of 25 There is room for improvement in the writing of care plans so that they give a more consistent standard of information across the home and staff can be aware of peoples needs and choices. More of the care staff should be given the opportunity to achieve a national vocational qualification in care to ensure that there is a well qualified staff team. Regular fire drills must be carried out so that all staff have the opportunity to attend fire drills and they know what to do in case of a fire. A record of the names of the staff attending should be kept so that the manager can see who has attended fire drills. 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 set out 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 8 of 25 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 9 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs had not always been assessed in any detail before they moved to live at Vale Court so staff did not have good information about the care they required. Evidence: Since our last visit to Vale Court the accommodation has been reconfigured to make two living units on the ground floor, one for older people receiving personal care and one for adults with a physical disability, and one unit on the first floor for older people receiving nursing care. On the day we visited there were 12 older people and 13 younger people living on the ground floor, and 29 people on the first floor. In the annual self assessment the previous manager told us that: Prospective residents have an assessment completed prior to admission to ensure that their individual needs can be met. Care plans appropriate to that assessment are completed within 24 hours of admission using a person centered approach and those plans are Care Homes for Older People Page 10 of 25 Evidence: then reviewed after seven days to make sure they are accurate and appropriate and are added to if necessary in consultation with families. We looked at care plans for three people who came to live at Vale Court in the last few months. The pre-admission assessments were very brief and gave only basic information about peoples needs. This means that the staff providing the care did not have much information about new people coming to live at the home. For one of these people, a new full assessment had been written recently and this was a great improvement. Four Seasons provides a detailed assessment document which is a very useful tool if used correctly. The home has a new manager and she told us that either herself, the deputy manager, or the senior nurse for the ground floor units will go out to assess any people who are interested in moving to Vale Court. Care Homes for Older People Page 11 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the people living at the home are met and their medicines are well managed. Evidence: We looked at a sample of care plans on the ground and first floors, including people who have come to live at Vale Court recently and others who have been there for several years. The care plan documentation provided by Four Seasons is comprehensive and is based on a full assessment of peoples health and personal needs. The care plans are easy to follow but are very large and time-consuming for the nurses to complete. The standard to which care plans had been completed was variable, with some good examples and others quite poor. The regional manager told us that they were aware of which nurses were not completeing the care plans to a satisfactory standard and this was being addressed. The detailed social assessment had not been not filled in at all in two of the care plans we looked at. Daily records were generally good and gave a Care Homes for Older People Page 12 of 25 Evidence: picture of how the person spent their day and how they were feeling, but there were some examples of daily records which just recorded needs met, and this does not give any information. One of the care plans we looked at was for a person with long standing pressure sores. There were detailed records of the size and condition of the wounds and these showed that they were healing rather than deteriorating. Although there was plenty of information, it was quite difficult to follow and would be better if a separate chart is used for each of the sores. A new bed was provided for this person in May 2009. We saw that where bedrails were used a risk assessment was recorded in the care plan, a consent form was signed, the rails were fixed safely to the bed and fitted with protective padded covers. We saw records of visits by community healthcare professionals and these included GPs, physiotherapist, continence advisor, multiple sclerosis nurse, optician and chiropodist. A social worker was providing support with the care of a resident with challenging behaviour. During our visit we spent a lot of time talking with residents and their visiting relatives. The general feeling was that they were very happy with the care provided and that things had improved considerably with the arrival of the new deputy manager and then the new manager. One person said the staff are fantastic and another said staff are lovely could not wish for better, treat you like a human being, always treat you with respect, I like this, they do not make you feel you are a trouble. Three people told us that there was a member of staff that they didnt get on so well with. They said that they would tell the manager or the deputy if this became a problem for them. We looked at the management of medicines on both floors and found that storage and recording were good. Medicines brought into the home are checked in and signed for. There were no missed signatures on the medicines administration records (MARs) and any handwritten additions to the printed MARs provided by the pharmacy were written in full detail and signed by two nurses. There were no tablets left over in the blister packs and this indicates that people had always received their prescribed medicines. The quantities of any medicines carried over from one month to the next were recorded. Controlled drugs were prescribed for residents on both floors. These were stored and recorded as required by legislation and a sample check of quantities showed they were all correct. One of the nurses told us that they had received medication training from Boots the day before our visit. Care Homes for Older People Page 13 of 25 Care Homes for Older People Page 14 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have choices about how they spend their time and social activities are provided for those who like to join in. Evidence: The home employs an activities organiser 30 hours a week. She told us that she has worked at Vale Court for nine years and used to be the housekeeper. She recently took on this new role because she wanted to get to know the residents better. She has just started to keep a record of activities so that no-one is missed out. The morning we visited she was baking with some of the ground floor residents. There is a fully equipped kitchen that residents can use. An activities programme is displayed and this includes craftwork, entertainment and trips out. Entertainment is usually held in the first floor lounge. A mobile library provides a service for the home. Members of the clergy visit and there is a monthly communion service. Two people are picked up on a Sunday to go to church, and one resident who is a Jehovahs Witness and goes to the Kingdom Hall. Care Homes for Older People Page 15 of 25 Evidence: We found that there was a relaxed atmosphere generally and staff were not rushing around. Friends and family were visiting throughout the day. The people we spoke with said that they could choose how they spend their day and where they have their meals. The people we spoke with were happy with the food provided, but unfortunately the chef will be off sick for a few weeks following an accident. Cooks from an agency are being used to support the homes assistant cook. One of the comments recorded by the home manager during June was food is 100 better. We observed one of the care staff helping a resident to eat lunch and saw that she had a very nice attitude and was very respectful to the person she was helping. Care Homes for Older People Page 16 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are protected from abuse and their complaints are listened to. Evidence: Four Seasons has a complaints procedure that tells people who to contact if they have a complaint and how their complaint will be dealt with. This is displayed in the reception area of the home. We looked at records of complaints that had been received in the last year and found that good records had been kept. The records showed that complaints had been investigated and responded to. Relatives who made a complaint in May 2009 had a meeting with the regional manager and it was agreed that a review would be held in July. The complaints record was updated on 30 June to record that the relatives were pleased with the improvements made and did not need another meeting. Four Seasons also provides policies and procedures that give staff guidance about how to recognise abuse and what their responsibilities are for reporting any issues. Training about this was given to the staff on 10 June 2009. Care Homes for Older People Page 17 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Vale Court provides a comfortable, clean and well-maintained environment for people to live in. Evidence: The home was purpose built and is light and spacious. All residents have a single bedroom of adequate size with en-suite facilities. There are enough lounges, dining rooms and bathrooms that are furnished and equipped to meet the needs of the people who live at the home. The large lounge on the ground floor has been refurbished to a good standard. The gardens have been improved and are safe and pleasant for residents to use. The nurses working on the ground floor now have an office where they can speak with visitors, do their written work, and keep residents records. There is soon to be a nurses office on the first floor, which is much needed. We found everywhere clean, tidy and well-maintained. There was an odour problem in one bedroom. The home has a new head housekeeper and some new cleaning equipment has been provided. The kitchen has been deep cleaned recently. Care Homes for Older People Page 18 of 25 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. Enough staff were provided to meet peoples needs when we visited, but this needs to be kept up consistently. Fewer than half of the care staff have a qualification in care. Evidence: Before our visit to the home we received three comments cards from members of staff. They all told us that the home was somtimes short staffed. One person wrote The manager never bothered to find ways to cover staff sickness or absences. Seldom suggest staff to ring for agency cover, to the point that staff on the floor have to work overtime all the time. The regional manager agreed that there had been issues about staffing levels but the numbers on the rotas are now being maintained. Other people who we spoke with during our visit confirmed that this was so. Two new staff are starting at Vale Court this week and another is waiting for references to be returned. Three people are on long term sick leave. The usual numbers for the ground floor are one nurse and three carers during the day, with one nurse and two carers at night. For the first floor there are two nurses and four carers during the day (maybe one nurse and five carers in the afternoon/evening), one nurse and two carers at night. On the day we visited this appeared to be sufficient and staff did not seem rushed, however staff numbers need to be flexible to reflect the dependency and care needs of the people living at the Care Homes for Older People Page 19 of 25 Evidence: home. At present 12 of the 34 care staff employed have an NVQ in care. This does not meet the target that was set by the Department of Health for at least 50 of care staff to have a qualification. The manager told us that she is unable to address this at present because NVQ is going to be organised through Four Seasons own training department and she has to wait for places to be allocated for Vale Court staff. We looked at the recruitment records for five people who have started working at Vale Court recently. The records were very good and neatly filed in individual folders. All of the staff had completed application forms and given details of their previous employment history. Interview notes had been kept on file. Criminal Records Bureau disclosures and satisfactory references had been received. There is a very comprehensive induction training programme for new staff and we were told that all new staff, including the manager, are working through the programme appropriate to their job. All staff have attended moving and handling training in 2008, and some in 2009. The records indicated that some staff have not had fire safety training since 2007, however we did see evidence that this is being addressed and the most recent fire training was on 3 June 2009. One of the care staff we spoke with said that she had recently done first aid, fire, continence, and moving and handling training; she said the training is great and she likes to attend courses. Care Homes for Older People Page 20 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Vale Court has a new management team who are committed to taking the service forward for the people who live and work there. Evidence: A new manager took up post at Vale Court at the beginning of June 2009 and she has started the process to be registered with the Commission as manager of this care service. She has considerable previous management experience with another large care provider. She has achieved the registered manager award management qualification. There is also a new deputy manager who joined Vale Court in May 2009. She has previous experience working as a home manager. Whilst it is early days yet, we received very positive comments about the new management team from the members of staff, residents and visitors who we spoke with during our visit. Several people told us that morale in the home had been poor but has now improved considerably. At the beginning of May 2009 we received Care Homes for Older People Page 21 of 25 Evidence: comments cards from three members of staff who all felt that problems, particularly with staffing levels, were not being addressed. People we spoke to during our visit said that staff numbers were now being maintained and the deputy manager had brought much better organisation to work routines on the first floor. They also appreciated the home manager spending time on the shop floor each day. There are various ways that the quality of the service is checked. At present the regional manager is visiting every week while the new manager settles in. She does the monthly monitoring visits required by regulation 26 of the Care Homes Regulations. There is a very lengthy and detailed company auditing tool that covers all aspects of the service and identifies any areas that need improvement. In addition, an annual customer satisfaction survey is sent out from head office, the last was in December 2008. The manager hasnt held any meetings yet for staff, residents or relatives. Good records of any complaints received are kept and the manager is also recording compliments as a way of monitoring progress. Seven have been received during June. The homes administrator is well established and residents and/or their relatives can discuss finances with her. There is a system for residents to be able to put small amounts of personal spending money in safe keeping. Detailed individual records are kept. The home has a full time maintenance person. He carries out a series of regular health and safety checks and keeps records of them. These including checking that any bedrails used are safely fixed to the bed. The fire alarm system is tested weekly. We were told that there has been no recent visit by a fire officer. The maintenance person is also fire warden for the home and has been providing training for the other staff. We did not find a record of any recent fire drills, however some members of staff who we spoke with said that they had attended fire drills. Information in the self-assessment indicated that all equipment had been checked and serviced as needed. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 23 of 25 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 38 23 Regular fire drills must be carried out and a record of the names of the staff attending should be kept. So that all staff have the opportunity to attend fire drills and would know what to do in case of a fire, and the manager can see who has attended fire drills. 22/07/2009 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 3 When a new resident comes into the home there should be as much information as possible for the staff who will be providing care for them. There is room for improvement in the writing of care plans so that they give a more consistent standard of information across the home and staff can be aware of peoples needs and choices. 2 7 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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