Care Home: Vallance Rest Home

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What the care home does well The relaxed, homely and welcoming environment at Vallance Rest Home reflects the stability and commitment within the staff team and the open and inclusive management style. Effective systems are in place for the admission and ongoing care of residents. Good quality individual care plans developed from comprehensive pre-admission assessments ensure that an individual`s needs are met in a structured and consistent manner. Communication and consultation with residents` family members is effective and ongoing. Relatives have the opportunity to partake in individual assessment, care planning and reviewing processes. What has improved since the last inspection? There were no requirements or recommendations made as a result of the previous inspection. A new controlled drugs cupboard has been purchased. All outside windows have been re-painted as have the front doors and windows at the back of the house. An industrial washing machine and tumble dryer have been purchased. The rubber matting on the rear ramp has been replaced to a more adequate standard. What the care home could do better: It is important that existing and prospective residents have accurate and up to date information about the service. Therefore a Statement of Purpose must be developed and implemented and the current Service User Guide should be reviewed. Due to the increasing dependency levels of residents within the home, it is essential that there are sufficient trained and competent staff on duty at all times to meet their assessed care and support needs. Residents must be given the opportunity for stimulation through a structured programme of recreational activities, including outings, which suit their needs and interests. The first floor bathroom, including rusty bath chair, is looking `tired` and is in need of redecoration and refurbishment. Key inspection report Care homes for older people Name: Address: Vallance Rest Home 7/9 Vallance Road Hove East Sussex BN3 2DA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nigel Thompson     Date: 0 8 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Vallance Rest Home 7/9 Vallance Road Hove East Sussex BN3 2DA 01273326053 01273207543 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Vallance Organisation Limited care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 19 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category; Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Vallance Rest Home is a privately owned residential home, which has been owned and managed by the same family since 1980. The home is registered for up to nineteen older people over the age of 65 years. The premises consist of two joined converted Victorian houses with resident?s private and communal accommodation over two floors. Resident accommodation consists of eleven single and four shared bedrooms, communal facilities consist of two interlinked lounges, a dinning room and a small rear garden. The front garden is partially paved to provide some off road parking. The home is located within walking distance of Hove Care Homes for Older People Page 4 of 28 Over 65 19 0 Brief description of the care home sea front and the local amenities and is served by public transport. The homes literature says that it aims to provide a warm, comfortable, secure and above all caring environment for all its residents and staff. As of October 2009, fees at the home range from £358.00 to £650.00 per week. There are extra charges for services such as hairdressing and chiropody and details of these are available from the home. Care Homes for Older People Page 5 of 28 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 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place over five hours in October 2009. It found that all of the key National Minimum Standards that were assessed had been met or partially met and the overall quality of care provided was good. The purpose of this inspection was to assess compliance with regulations and to generally monitor care practices at the home. On the day of the inspection there were nineteen residents living at the home. The inspection process involved observation of working practices, examination of the homes records and discussion with five residents, three relatives, two members of Care Homes for Older People Page 6 of 28 staff and the deputy manager. Each residents room was viewed, as well as all of the communal areas. Information about the service, contained in the recently completed Annual Quality Assurance Assessment (AQAA), has also been included in this report. The focus of the inspection was on the quality of life for people who live at the home. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 28 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 9 of 28 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 10 of 28 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. The admission policy and procedure is generally satisfactory and residents are admitted only on the basis of a full needs assessment, undertaken by people competent to do so. However, documentation, including the Statement of Purpose and Service Users Guide must be reviewed and updated to ensure that prospective residents and their relatives have sufficient accurate information about the home and the services provided. Evidence: There is currently no Statement of Purpose in place and although a Service User Guide was made available for inspection, it is evident that the document, including the complaints procedure, has not been reviewed or updated recently. As discussed with the deputy manager, it is required that a statement of purpose be developed, in accordance with Schedule 1. It is important that details contained in these documents be kept under review, so as to accurately reflect the services provided and the current situation within the home. Care Homes for Older People Page 11 of 28 Evidence: The deputy manager confirmed that the admission process provides the opportunity for prospective residents to visit the home before moving in to look around and meet with existing residents and staff. Having moved in, there is a flexible trial period, of continual assessment, during which time the suitability of the service and the compatibility of the resident can be established. Through examination of files relating to residents who have moved into the home since the previous inspection, there was documentary evidence of a comprehensive needs assessment having been carried out. The Assessment Tool is used to evaluate an individuals areas of need, including all personal care and support needs, any mental health and mobility issues, social and cultural needs and family involvement. Residents and relatives, spoken with during the inspection, were able to confirm that, despite the minimal staffing levels, the home appears to meet their individual needs and aspirations: Everyone here seems so kind and helpful. They cant do enough for you. I cant fault the place. Ive certainly got no complaints. I am reassured that my mother is safe and being well cared for. The deputy manager confirmed that intermediate care is not provided at Vallance Rest Home. Care Homes for Older People Page 12 of 28 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. Individual care plans enable staff to meet residents assessed health care needs in a structured and consistent manner. Residents are protected by the homes medication policies and procedures. Systems for consultation and participation could be improved, however residents are treated with respect and, where appropriate, are encouraged to make decisions about their day to day living. Evidence: Residents care plans that were viewed were found to be generally well maintained and up to date. They showed clear links with the individuals assessed needs and contained details of action and intervention to be taken by staff to ensure consistency of care. There was also evidence of plans being regularly reviewed and updated. The deputy manager confirmed that residents and their relatives are given the opportunity to take part in developing and reviewing individual care plans. However, in plans that were examined, there was little documentary evidence of residents or family members being involved in this process. It is recommended that that this issue be addressed. Care Homes for Older People Page 13 of 28 Evidence: All residents are registered with local GPs and have access to other health care professionals, including district nurses, via the surgeries. It was noted, in care plans that were examined, that all appointments with, or visits by, health care professionals are recorded. Nutritional screening is carried out as part of the initial assessment procedure. The home continues to operate an effective key worker system. As part of their induction programme, the deputy manager confirmed that all staff receive instruction on the principles of dignity and respect. This was evident, through discussion during the inspection, and from direct observation of staff interacting sensitively and professionally with residents. Satisfactory and up to date policies and procedures are in place for the control, storage, safe administering and recording of medication. The deputy manager confirmed that all staff involved in administering medicines receive appropriate training. This was supported by documentary evidence and through discussions with care staff. Following risk assessments, there are currently two residents in the home who evidently maintain responsibility for administering their own medication. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from menus that are balanced and nutritious, reflecting their individual likes and preferences. Residents are enabled and supported to maintain contact with family and friends as they wish, however, their opportunities for appropriate recreational and leisure activities are limited. Evidence: It is evident that there is little in the way of structured activities, including outings. Three afternoons a week, where practical, one of the two members of staff on duty would be expected to organise some form of entertainment or activity within the home. Although not all residents enjoy or partake in organised group activities the deputy manager confirmed that the member of staff would also visit and spend time with residents who prefer to remain in their room. However this current loose arrangement for providing activities is unsatisfactory and residents recreational opportunities are clearly restricted and limited by the minimal staffing levels. Comments from some residents spoken with during the inspection, indicate that, in addition to having more information regarding in house activities, they would like to have the opportunity to go out of the home more often: Care Homes for Older People Page 15 of 28 Evidence: We dont do much and I never really know whats going on. I never go out unless its with my family. Residents are provided with a varied, wholesome and nutritious diet. At lunchtime a choice of main meal is available and special diets are catered for. As part of a four week rolling menu, a daily menu is displayed, reflecting residents preferences and including seasonal variations. Positive comments received from residents and relatives demonstrate overall satisfaction with the variety and standard of the food provided: The cook here does a very good job and the meals are excelllent. I know that my mother always enjoys her food. The deputy manager confirmed that, in accordance with the wishes of the residents, visitors to the home are made welcome, at any reasonable time. However, they are asked to respect mealtimes. Residents may see friends or relatives in one of the lounges or in the privacy of their own room. Care Homes for Older People Page 16 of 28 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. The open and inclusive atmosphere within the home enables residents, staff and visitors to express any concerns, confident that they will be listened to and acted upon. Residents are safeguarded from abuse through relevant staff training and robust policies and procedures. Evidence: Residents, relatives and members of staff spoken to described how the manager and deputy manager operate an open door policy and are generally considered to be approachable and understanding. They confirmed that they would have no hesitation in speaking to either of them or making a complaint if necessary and each person was confident that they would be listened to: Everything at the home is to my satisfaction. I have no complaints. My mother would not know how to complain, but I feel confident that if I needed to complain on her behalf I would be listened to and Im sure that it would be dealt with appropriately. The home has a detailed Safeguarding Adults from Abuse policy and procedure in place in line with multi-agency guidelines. The deputy manager confirmed that staff are also made aware of these key policies Care Homes for Older People Page 17 of 28 Evidence: and procedures as part of their induction, foundation and National Vocational Qualification (NVQ) training and they are reinforced during regular supervision sessions and staff meetings. Relevant training relating to safeguarding adults is provided for all staff. This was supported by training records examined and confirmed by members of staff, spoken with during the inspection. Care Homes for Older People Page 18 of 28 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. The service is homely, accessible and safe and is clearly suitable for its stated purpose. Residents benefit from pleasant accommodation that is comfortable, clean, well maintained and decorated to a satisfactory standard. Evidence: Vallance Rest Home is an established service and both its location in a residential area of the city and its accessible layout remain clearly appropriate and suitable for its stated purpose. There has been little change in the physical environment since the previous inspection and with the well maintained decor and good quality furniture and furnishings it continues to provide a comfortable, safe and homely environment for residents. As discussed, the first floor bathroom, including rusty bath chair, is looking tired and is in need of redecoration and refurbishment. Residents bedrooms were found to be clean, comfortable and generally well maintained. It was evident that many of the rooms have been personalised, with pictures, family photographs and other small items of furniture and personal belongings, to reflect individual taste, choice and preference. Care Homes for Older People Page 19 of 28 Evidence: Residents and relatives, spoken with during the inspection, expressed satisfaction with physical standards within the home: Whenever I visit, the place is always looking clean and tidy. My mother really likes her room and has everything that she needs at hand. It feels like home from home. A programme of routine maintenance, refurbishment and renewal is in place. Infection control procedures within the home are in place and are closely adhered to. Levels of cleanliness and hygiene remain generally high throughout. Care Homes for Older People Page 20 of 28 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. Robust recruitment procedures and appropriate staff training help to ensure the safety and protection of residents. However, as the dependency levels of residents increase there are potentially insufficient trained and competent staff on duty to effectively meet their changing care and support needs. Evidence: There are some concerns regarding the minimal staffing levels at Vallance Rest Home. Through discussion with the deputy manager and from examination of the rota, there are evidently two care staff routinely on duty during the day, plus management cover. There is one waking night staff on shift between 8.00pm and 8.00am. There are currently nineteen residents at the home, some of whom are presenting signs of dementia and many of whom, according to their individual care plan require full personal care. Despite the increasing levels of incontinemce, the deputy manager confirmed that there are only two baths scheduled, morning and evening. As previously documented the staffing levels also have a direct impact on the residents social and recreational opportunities. This situation was also reflected in comments from residents relatives: Care Homes for Older People Page 21 of 28 Evidence: The staff can only do their best, and they do, but Im sure that if there were more carers on duty then people like my mother who need increasingly more help would not have to wait so long. Robust recruitment procedures are in place. Personal files, relating to newly appointed staff, were found to be well maintained, containing all necessary information, including two written references, proof of identity and satisfactory Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. The deputy manager confirmed that appropriate induction, foundation and core skills training is provided, including first aid, moving and handling, food hygiene and fire safety. Staff have also undertaken specific training relating to dementia awareness. This was confirmed by staff and supported by training records examined. Care Homes for Older People Page 22 of 28 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. Residents benefit from effective management, appropriately supervised staff and thorough quality assurance systems. Satisfactory health and safety policies and procedures, within the home, help to ensure the protection of residents and staff. Evidence: The atmosphere in the home remains relaxed, friendly and welcoming. Staff, spoken to during the inspection felt valued and supported by the deputy manager and confirmed her open and approachable style of leadership and clear and positive sense of direction. The deputy manager is competent and experienced and has been in her current post for over five years. She holds both the Registered Managers Award (RMA) and NVQ level 4, in management and care. Formal, recorded supervision is provided for all care staff on a regular basis. Care Homes for Older People Page 23 of 28 Evidence: Through discussions with members of staff, it is evident that the deputy manager continues to operate an open door policy, with staff encouraged and able to discuss any issues or concerns that they may have at anytime. This was further reinforced by comments made by residents relatives, spoken with as part of the inspection process: I am kept regularly informed of any incidents or changes in my mothers health or circumstances. The homes quality monitoring system includes satisfaction questionnaires for both residents and their relatives. The deputy manager confirmed that recent surveys have been sent out although, as yet, only a few responses have been received. The deputy manager confirmed that the home maintains responsibility for residents allowances. Individual balances are checked on a regular basis and all financial transactions are recorded. The health, safety and welfare of residents and staff remains of paramount importance within the home and staff training is provided in many aspects of safe working practices, including moving and handling, food hygiene, fire safety and first aid. COSHH assessments and guidelines are in place. Temperature regulators are fitted to all hot water outlets, accessible to residents. All accidents, incidents and injuries are recorded and reported, as required. Care Homes for Older People Page 24 of 28 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 25 of 28 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 1 4 It is required that a 30/11/2009 Statement of Purpose be developed and implemented, in accordance with Schedule 1. Prospective residents and their relatives have the information about the service that they need to make an informed choice about where to live. 2 1 5 It is required that a copy of the Service Users Guide be reviewed, updated and made available to each current and prospective resident. Existing and prospective residents have accurate and up to date information about the service. 30/11/2009 3 12 16 It is required that residents be given the opportunities for stimulation through a structured programme of 30/11/2009 Care Homes for Older People Page 26 of 28 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 recreational activities, including outings, which suit their needs, preferences and capacities. Activities provided are flexible and varied to meet residents identified interests and expectations. 4 27 18 It is required that there are sufficient trained and competent staff on duty at all times to meet the assessed care and support needs of residents. Staffing numbers and skills are appropriate to the increasing dependency levels of residents. 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 30/11/2009 1 19 It is recommended that the tired looking first floor bathroom be redecorated and refurbished. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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