Care Home: Valewood House

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What the care home does well Potential new residents benefit from a through pre- admission assessment that allows for only those who needs can be met, being admitted to the home. The health needs of residents are well met with evidence of good multi disciplinary working taking place. Staff provide personal support to residents in such a way that promotes and protects resident`s privacy and dignity. Resident`s benefit from a well planned activities calendar that is both stimulating and meaningful and arranged according to their choice. Residents experience mealtimes that are unhurried, whilst all meals are home cooked with an alternative option being available for each mealtime. Resident`s can be assured that there is an efficient complaints procedure in place and that the homes processes and staff training should protect residents in the event of an allegation of abuse. The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to residents. Resident`s experience the benefits of a staff team that have the necessary skills and experience to the meet their needs. Staff training is on going and is appropriate to the level of needs of current resident`s.The management and administration of the home is good, with evidence of consideration being given to resident`s and/or relatives opinion at all times. What has improved since the last inspection? The Management of the home have taken appropriate measures to ensure that a system for evaluating the quality of the services provided, which includes consultation with resident`s and their representatives has been established and maintained. All communal bathrooms pipes have been fitted with mixer valves to ensure that hot water provided for the use of both residents and staff, is now within the safe temperature limits required. CARE HOMES FOR OLDER PEOPLE Valewood House Bell Vale Lane Haslemere Surrey GU27 3DJ Lead Inspector Rebecca Shewan Unannounced Inspection 18th March 2008 09:25 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 Valewood House DS0000024233.V360818.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. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Valewood House Address Bell Vale Lane Haslemere Surrey GU27 3DJ 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) 01428 644670 valewood@btconnect.com Valewood House Nursing Home Limited Mrs Shirley Ann Houghton Care Home 40 Category(ies) of Dementia (40), Dementia - over 65 years of age registration, with number (40), Mental disorder, excluding learning of places disability or dementia (40), Mental Disorder, excluding learning disability or dementia - over 65 years of age (40) Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only service users over 40 years of age in the DE and MD category may be admitted. 7th November 2006 Date of last inspection Brief Description of the Service: Valewood is a care home with nursing was registered in July 2002 and provides accommodation and both personal and nursing care for up to 40 service users in the categories of Dementia and Mental Disorder. The home is privately owned by Valewood House Nursing Home Limited. Located on the outskirts of Haslemere, Valewood House is a large country house that has been extended to provide additional accommodation. The home is a large detached property, set some distance from the road. Inside there are comfortable sitting and dining areas, domestic in character and a passenger lift provides access to the first floor. It has 32 single bedrooms, and 4 shared bedrooms. There is generous parking space to the front of the property and extensive well-established grounds with a large lake, which have been landscaped to provide safe seating and walkways by the lake. The range of fee’s charged for services provided are £600 - £760 per week. Fees do not include hairdressing (£8 for a basic cut), Chiropody (£8 per session) and some outing costs such as theatre tickets and entrance fees (varied). Potential new service users can obtain information relating to the home by word of mouth, CSCI inspection reports, placing authorities/care managers, contacting the home direct, Social Services, GP lists, Alzheimer’s Society website and Registered Nursing Home Association Website. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place during the morning and afternoon of the 27th March 2008. Incident reports and previous inspection reports, held by the Commission for Social Care Inspection, were read before the inspection. The inspection of the home took six and a half hours. Records such as care plans, staff files and medication records were also viewed. Thirty nine service users (known as residents) were accommodated at the home at the time of the inspection. A tour of the whole home was undertaken and the Registered Manager, Deputy Manager and three staff were spoken with. What the service does well: Potential new residents benefit from a through pre- admission assessment that allows for only those who needs can be met, being admitted to the home. The health needs of residents are well met with evidence of good multi disciplinary working taking place. Staff provide personal support to residents in such a way that promotes and protects resident’s privacy and dignity. Resident’s benefit from a well planned activities calendar that is both stimulating and meaningful and arranged according to their choice. Residents experience mealtimes that are unhurried, whilst all meals are home cooked with an alternative option being available for each mealtime. Residents can be assured that there is an efficient complaints procedure in place and that the homes processes and staff training should protect residents in the event of an allegation of abuse. The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to residents. Residents experience the benefits of a staff team that have the necessary skills and experience to the meet their needs. Staff training is on going and is appropriate to the level of needs of current residents. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 6 The management and administration of the home is good, with evidence of consideration being given to resident’s and/or relatives opinion at all times. What has improved since the last inspection? 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. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 7 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 Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has processes in place for assessing potential new resident’s with services being offered to only those resident’s whose needs can be met. EVIDENCE: The home’s Registered Manager carries out pre- admission assessments. The Registered Manager obtains copies of care management assessments from the placing authority, where these exist. The Registered Manager addresses any issues, which are highlighted within this assessment. Documented records are maintained of all correspondence with the placing authority. Records inspected showed that pre- admission assessments are carried out on all new and potential residents. Intermediate care is not offered by this home. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are offered a good provision of health care and personal support by the home. All care is administered in way that protects residents privacy and dignity. Medication procedures ensure that all necessary precautions are taken to ensure errors do not occur and that medications are stored and administered safely. EVIDENCE: Care plans were sampled and it was evidenced that they were comprehensive, detailed in content and covered all aspects of resident’s needs. Care plans are written to allow the assessor to gain a good overview of individuals medical, nursing, mental health, social and personal care needs and provide the assessor with a clear overview of the Residents current needs, limitations and required assistance. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 10 From the records sampled and from discussions with staff, it was evidenced that the health needs of residents are well met with evidence of good multi disciplinary working taking place, on a required basis. Residents are registered with a GP from the local surgery. Service users can see another GP from this practice if requested or can keep their own GP if they are from the local area. The GP from the local practice attends the home fortnightly to conduct a ‘surgery’, whereby residents are assessed and reviewed as needed. The community dentist attends to residents dental needs on a yearly and ad hoc basis. Optician’s appointments are maintained yearly. Physiotherapy can be arranged via the hospital or can be provided in house. The home has an Aromatherapist who visits the home monthly. Access to a Psychiatrist is arranged via one of the two local Primary Care Trusts (PCT) or hospitals, psychiatrist visits are arranged for each resident on a four to six weekly basis. The service has it’s own Occupational Therapist. Community Mental Health Teams (CMHT) are accessed by the home directly. Community Mental Nurse (CMN) appointments are arranged through the local GP practice. Audiology appointments are arranged via the GP. Diabetic nurse resources are available and residents attend such appointments at the local GP practice. The Registered Manager reported that where possible all residents are encouraged to attend their appointments externally, with assistance as required. The home has good procedures in place for the monitoring and recording of all drugs (including oxygen therapy) administered, disposed of and those entering and leaving the home. The stores for medication were viewed and these were found to be maintained in a clean and orderly manner. Medication administration records were viewed and these were found to be maintained appropriately and in accordance with the Nursing and Midwifery Council (NMC) Standards for medication and management. Staff training in medication is conducted as part of the Induction process. Staff were observed providing personal support to service users in such a way that promoted and protected residents privacy and dignity. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience Excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home provides a wide range of social, cultural and recreational facilities, including specialist diets to residents, with resident’s choice and wishes being respected. EVIDENCE: The home has a social club, which has a snooker/pool table, games, puzzles, arts and crafts. Each service user is welcome to attend the social club every afternoon. The home also has the resources to conduct stool/soap/card making, clay crafts, Arts and Crafts, music therapy, relaxation therapy, motor skills training, sensory skills (lights, sounds and music) and weekly bingo. There is an ‘in house entertainment’ group that conducts shows/sketches etc. External activities include: walks around the grounds, town shopping (with or without assistance, as risk assessed), trips to places of local interest, theatre trips, picnics in the ground (weather permitting) and town visits for hairdressing and personal shopping. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 12 The home has a ‘Rehab Unit’, which is utilised by the Occupational Therapist for training residents to be self caring with their washing, cooking and other daily activities. Resident’s religious wishes are observed and arrangements are in place for residents to receive Holy Communion and confession, if they wish. Discussions with the Registered Manager highlighted that although the current residents had similar religious beliefs, the home would welcome any potential new resident who has special cultural/religious/spiritual beliefs and would make provision to accommodate their needs. The management of the home believes in promoting an equal and diverse culture among staff and residents. Residents are encouraged to attend local community events, one resident is assisted to attend the local Luncheon Club on a weekly basis. Contact with family and friends is positively encouraged with visitors being able to attend the home at any time and in accordance with the resident’s wishes. Residents are treated with respect and there is a good rapport between staff of the home and residents. Residents reported that the home assists them to maintain their independence with their daily living and daily routines. The home’s menus are devised on a six week rolling programme. All meals are home cooked with an alternative option available for each mealtime. Mealtimes can be varied upon request and residents guests are also welcome to have meals at the home. Medical, therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. The meal served during the inspection was ample in quantity and attractively presented. Mealtimes were observed to be unhurried. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a robust and efficient complaints procedure, whilst the homes procedures, processes and staff training should protect resident’s in the event of an allegation of abuse. EVIDENCE: The home has an established complaints procedure in place. The home has received nine complaints within the past twelve months, all of which have been recorded as addressed within the response time specified by the home’s policies and procedures. Each of the complaints have been resolved and appropriate action was taken by the Registered Manager to address the concerns raised. Criminal Record Bureau (CRB) checks have been carried out on all existing staff. Both CRB and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. Verification of nursing staff’s registration to practice is obtained from the NMC prior to nursing staff commencing employment. Staff have attended training in the Protection of Vulnerable adults within the last twelve months. This was evident from the staff files that were viewed and from discussions with staff. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides accommodation for residents that is safe, hygienic and odour free, whilst infection control procedures are adhered to at all times. EVIDENCE: The location and layout of the home are suitable for its stated purpose. The home is well maintained and all areas of the home, including the garden, are accessible to residents. The home has an ongoing plan of refurbishment in place. There is current work underway in the homes garden area, to accommodate a purpose built ‘sensory garden’, which has been specifically designed for residents to benefit from. The home has an infection control policy in place and staff are trained in infection control procedures, staff training records viewed confirmed this. Staff Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 15 were observed adhering to infection control procedures. The home was clean and odour free throughout. There is a daily cleaning schedule in place. It was evidenced that a clinical waste contract is in place. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a staff team that have the necessary skills and experience to the meet the needs of current residents. EVIDENCE: A competent staff team, sufficient in number, meets the resident’s needs. There is a staff rota in place, which details staff designations and hours of working. The home has a permanent staff team of Two Deputy Managers (both of which are Registered Mental Nurse’s), one Senior Nurse (who is an Enrolled Mental Nurse who holds an National Vocational Qualification (NVQ) level four in Management), one Registered General Nurse (RGN), one Registered Mental Nurse (RMN), one dual qualified RMN/RGN, seventeen care staff, two cooks, one maintenance manager, four domestics and three laundry staff. Of the seventeen care staff, five are trained to NVQ level two (in care) or above and a further six care staff are currently undertaking the training. The Registered Manager confirmed this. Staff recruitment files were viewed and it was evidenced that these files contain all items required under the Care Homes Regulations 2001. Some of Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 17 the current staff team are from abroad. All necessary visa and Home Office related documents were found to have been obtained and kept on file for these employees. The home has an Equal Opportunities policy in place and is an equal opportunities employer. Staff induction training is conducted in line with Care Skills Sector guidance. Mandatory training consists of Health & Safety, Fire Safety, Moving and Handling, Infection Control, Induction, Control of Substances Hazardous to Health, Protection of Vulnerable Adults and Conduct and Appearance. Additional training is also provided in Catheterisation, Medication, challenging behaviour, Dementia Care, Alzheimer’s, Mental Health issues, first Aid, nutrition and any other subject that may be related to the level of needs of residents. Registered Nurses spoken with at the time of the inspection said that they felt the training provided was good and provided them with the opportunity to achieve their Post Registration Education and Practice (PREP) requirements, as governed by the NMC. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents experience the benefits of a home that is well managed and administrated. Consideration is given to resident’s choice and opinion in all aspects of provisions provided. The health, safety and welfare of residents and staff are protected at all times. EVIDENCE: The Registered Manager of the home has worked there for thirteen years, is a qualified RMN and has been employed in the Mental Health sector for over thirty years. Staff spoken with said that the Manager was friendly, approachable and always takes residents concerns or comments about the home seriously. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 19 Following the inspection of November 2006 improvements have been made to ensure that the Statutory Requirement that the provider will establish and maintain a system for evaluating the quality of the services provided which provides for consultation with service users and their representatives has been met in full. There is now a comprehensive Quality Assurance Policy and procedure in place that involves continual self-monitoring of the home by the Registered Manager. Quality Assurance processes consist of resident’s meeting that are held three to four times a year, the records of which are maintained for all meetings held. Staff meetings are held once a month and ad hoc, as necessary. All such meetings are minuted, which were viewed at the time of the inspection. Questionnaires of staff, residents and relatives are conducted annually (and ad hoc if any incidences occur which require a review by the management of the home). The results of questionnaires are given to staff individually and are given collectively to residents (records are maintained of all feedback meetings held by the Registered Manager). The Registered Manager meets regularly with other stakeholders and community persons to discuss the nature of the home, documentation is maintained of all such meetings held. Some residents have ‘‘bank accounts’, which are monitored by the Registered Provider. The system is such that all records, relating to these accounts, are locked in the homes administrative office. The system is such that residents are invoiced by the Registered Manager for all transactions (such as hairdressing, chiropody, outings etc), the homes accountant then conducts all necessary transactions/debits from the residents account and reimburses the home. Itemised bank statements are maintained to provide a clear audit trail of all transactions made. The Registered Manager reported that residents who are able manage their own accounts. Two residents currently maintain their own finances. The remaining residents have family, friends or representatives who protect their financial affairs. Since the inspection of November 2006 improvements have been made to ensure that the Statutory Requirement that the registered manager shall ensure that hot water provided for the use of residents and staff is within safe temperature limits has now been met in full. The home’s maintenance files were viewed and it was evident that fire drills, fire alarm testing and fire equipment checks, health & safety checks and water checks had been carried out. There were no health & safety issues noted at the time of this inspection. Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 20 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 3 X 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Valewood House DS0000024233.V360818.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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