Care Home: Vanehill Specialist Care Homes

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What the care home does well The home is one of the very few specialist homes in the country to support people with Korsakoff`s Syndrome. This is a condition with symptoms similar to a dementia such as poor short term memory, brought about by excessive alcohol use. People who live at Vane Hill have a sufficiently well-maintained, clean, and safe environment. Their needs are properly assessed and care plans are drawn up to ensure that they receive appropriate care and support. This includes good food and appropriate medical attention. People who live at the home are encouraged to retain and develop interests, in particular to take regular exercise. They are enabled to have contact with their families. They are supported by competent and trained staff, are protected from abuse and have access to a complaints procedure and independent advocacy. The home is recognised as being well run by being awarded an "Investor in People". What has improved since the last inspection? Individual`s needs assessment, risk assessment and care planning processes have improved to become more person centred rather than service led. These now allow people to go out more alone into the community and so enhance their confidence regarding rehabilitation, which is more likely. The home now offers choice over meals including a healthier diet Complaints are now recorded along with the action taken to resolve them. The environment has improved both inside and outside by the construction of two conservatories, ongoing maintenance including replacement of some of the windows and additional equipment, including a minibus. All these enhance the quality of life for those who live in the home. Staff training has improved. The qualification level far exceeds the standards and the home has been awarded an Investor in People. What the care home could do better: The registered persons must continue to modernise individual`s needs assessment, risk assessment and care planning processes to become more person centred rather than service led. This will help to ensure that the people who use the service are able to exercise more control over their lives and regain their independent living skills. Although the home meets the environmental standards, consideration could be given to enhancing the privacy and dignity of people who live in the home. For example, by reducing the number of double bedrooms and providing more ensuite bath and/or shower rooms in line with the current standards for newly built accommodation and best practice. CARE HOME ADULTS 18-65 Vane Hill 15 - 72 Vane Hill Road Torquay Devon TQ1 2BZ Lead Inspector Peter Wood Unannounced Inspection 15 & 16 October and 05 November 2007 10:00 Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 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 Vane Hill DS0000018445.V344618.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 Adults 18-65. 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. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vane Hill Address 15 - 72 Vane Hill Road Torquay Devon TQ1 2BZ 01803 298727 01803 299024 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) http:/www.notarohomes.co.uk/ Mr Nunzio Notaro Mr Steven William Sydney Todd Care Home 32 Category(ies) of Past or present alcohol dependence (32), Past or registration, with number present alcohol dependence over 65 years of of places age (32) Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No Service Users to be admitted under the age of 40 Key 26 & 27 September 2006 Random 18 January 2007 Random 2nd May 2007 Date of last inspection Brief Description of the Service: Vane Hill is registered to provide accommodation and care for a maximum of thirty-two people in the registration categories of Alcohol Dependency (past or present) and Alcohol Dependency (past or present) over 65 years of age. A condition of registration is in place restricting admission to people over forty years of age. Vane Hill provides medium to long-term residential care. The service does not provide detoxification or therapies, but does provide a programme to aid recovery, re-ablement and rehabilitation. The home now almost exclusively caters for people who have Korsakoff’s Syndrome. In order for readers to have a better understanding of the operation of this home, it may be helpful to include some information about the condition taken from the website of the Alzheimer’s Society (below). The home is made up of two separate houses next to each other at the end of a cul-de-sac in a quiet residential area in Torquay. Vane Hill is within walking distance to the town centre, but is at the top of a hill and so the walk back is quite strenuous. Information about the Home and service is available from the service provider in the form of a written Statement of Purpose and a Service Users’ Guide. Copies of inspection reports can be provided by the home, from the website of the provider, or from the CSCI website. At the time of the inspection the registered manager said that the fees were between £550 and £650 a week. This covers the cost of the accommodation, board and care but extra charges are made for optional services such as private chiropody and professional hairdressing, TV and video hire and other items of a personal nature. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We (the Commission) undertook this key unannounced inspection over one and a half days in October 2007. Our focus of this inspection was to inspect all key standards and to seek the views of people who live at the home, staff, relatives and professional visitors to the home, the latter mainly using survey forms. At the time of writing this report four staff returned the “Care Workers Survey” form, while seven survey forms were received from people who live at the home. We consulted all people who live at the home who were home at the time of the inspection. We spent considerable time with the Registered Manager examining documentation, particularly that relating to client assessment and care planning, staffing and health and safety. We selected and closely examined a selection of files of staff and people who live at the home. We also consulted staff who were on duty, including attending a meeting with four of them. We undertook a full tour of the building while we observed directly and indirectly the way the home operates. We also took into account the Annual Quality Assurance Assessment written by the manager, extract of which are quoted in this report. What the service does well: The home is one of the very few specialist homes in the country to support people with Korsakoffs Syndrome. This is a condition with symptoms similar to a dementia such as poor short term memory, brought about by excessive alcohol use. People who live at Vane Hill have a sufficiently well-maintained, clean, and safe environment. Their needs are properly assessed and care plans are drawn up to ensure that they receive appropriate care and support. This includes good food and appropriate medical attention. People who live at the home are encouraged to retain and develop interests, in particular to take regular exercise. They are enabled to have contact with their families. They are supported by competent and trained staff, are protected from abuse and have access to a complaints procedure and independent advocacy. The home is recognised as being well run by being awarded an “Investor in People”. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 6 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. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs, abilities and disabilities of people who may come to live at the home are now properly assessed before they come. They have sufficient information to help them and their sponsors make up their minds, and have a contract when they come. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment: “When a possible client is refered to come into care the first action is gain as much information about this person as possible then we will carry out a on site full assessment of this person in their own home or Hospital or hostel etc, during which time more valuble information will be gained about this person, and a face to face assessment can be made, we then collate all the information and have a meeting sometimes with staff and management about the facts and information and to if we will consider to take this person or not, then arrangements are made if a bed is available,also a possible resident would have signed a pre- admit agreement prior to coming in to our home which confirms that they wish to come and they have had all the information about the possible placement given to them and that they understand that information.” Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 9 We examined a selection of files of people who live at the home. These demonstrate that most referrals are from care management (Social Services/Care Trusts) and the home has received written assessments of their needs prior to admission. Some of the initial care management assessments seen on the files of people who live at the home were several years old and would not meet the current requirements, but we saw four newer assessments which were more detailed. These referrals are usually appropriate, made on the basis of professional assessment prior to admission. The manager also undertakes his own assessment to ensure that only those prospective residents whose needs can be met are admitted. As this is a specialist home with a national catchment area the manager visits prospective clients at their homes, hospitals or prisons throughout the country. The home continues to liaise with clients ex-carers & family after admission to ensure clients needs are fully met. The registered manager maintains contact with the service users Care Managers and has been proactive in ensuring that they visit the home to review their client’s needs on a regular basis. The Notaro group maintains a useful website and produces an attractive and informative brochure detailing the facilities of the seven very different care homes within the group. Information, such as that reproduced above from the website of the Alzheimer’s Society home, is given to prospective clients, their carers and sponsors. The home has a statement of purpose and a service user guide which contains details of the services and facilities provided. People who may come to live at the home have the opportunity to visit the home, meet other people who live at the home and stay overnight as part of the assessment process. All those who come to live at the home have a trial period and a valid contract. The needs assessments are now more person centred, and the signatures of people who live at the home now appear on several documents including risk assessments. However, owing to the condition of those who live at the home it is debatable whether such signatures guarantee that they genuinely agree to potential restrictions on individual choice and freedoms which form part of living in this home, albeit to protect and safeguard themselves and fellow residents. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home can be confident that their care will be planned. The home could improve its recording system to demonstrate more clearly how people who live at the home are involved in their plans, and how these plans are implemented. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment: “We promote each individuals needs and choices by giving each resident a chance to develop their own personality in the home and to participate in activities and tasks of their own choice and by their own freewill, we encourage each resident to do this by giving each resident the chance to risk take , like going out by themselves, handling small amounts of money when out and also giving residents the chance to attend day care in the community and take part Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 11 in off site work related tasks with others doing painting, brickwork, carpentry etc.” As part of the inspection process we examined a selection of files of people who live at the home. These have been improved to reflect recommendations made at a previous inspection. Each person who lives at the home has at least two files – a “personal file” (containing information that care staff do not need to know) and a “care file” (containing information that care staff need to know in order to provide appropriate care and support). We saw evidence that care plans are drawn up and regularly reviewed, but we did not see much evidence that people who live at the home are actively involved in the development of their care plans. Care plans and reviews did contain goals and personal aspirations, but these were generally long term goals, for example to move back into the community. They need to include smaller, time -related and more easily achievable goals as part of a process of re-enablement and to help individual residents reach their ultimate goal. The home does not provide detoxification or therapies, but does provide a programme to aid recovery, re-ablement and rehabilitation. Although the documentation did not necessarily reflect the practice, we saw lots of examples where people who live at the home were working towards an eventual return back to the community. Some people who live at the home were actively engaged in jobs around the home and neighbourhood such as cleaning, cooking, gardening and carpentry. Some people told us that undertaking these jobs gave them self – esteem, the habit of working, and skills needed in the wider employment world, all directed towards eventual rehabilitation. Many people who live at the home also undertake training with staff, and display the certificates received on their walls with pride. The manager is keen for those who live at the home to maintain a portfolio of achievements which they can show to a potential employer when they leave. We had considerable discussion with the manager about the purpose of the home, what it hopes to achieve, and how these achievements can be measured. Several clients have left the home following a period of rehabilitation and are reported to be coping well living in the community. However, the step from full time care into total independence is a huge one for anyone, but especially for clients of this home, some of whom have lived on the streets, or in psychiatric hospitals or prisons prior to admission to the home. We discussed the potential benefits of establishing a form of supported living for those who were ready to leave full time care but not yet ready for total independence. This could provide sharper focus regarding the purpose of the home, not only to provide a home for life for those who and need that, but particularly to enable clients to return to the community by equipping them with the skills they need to take that large step, but in small stages. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 12 Daily records are kept. Although daily recording has improved and is now more closely linked to clients’ individual plans, they still do not provide a true system of assessment which generates a plan which is implemented. While the individual’s plan of care is generated from the individual’s assessment, the recording of what the client does on a daily basis has no such close connection. What people who live at the house do on a daily basis, and the way that is recorded, could be linked better to their care plan. The daily recording does not record how the care plan is implemented on a daily basis, though periodic reviews do. The Registered Manager is proactive ensuring that care managers of their clients are well informed by the home and attend the home for regular reviews. Because the service provides care and support for people who have a history of alcohol abuse, some restrictions are in place to protect and safeguard them. However, the process of risk assessment tends to be service rather than person centred, where individual’s assessments are exceptions to the general rule. For example, most residents queue up to hand over their cigarettes, tobacco and lighters when they go to their rooms. This is to prevent them from smoking in their rooms, which is not only now unlawful but is always a potential fire risk. Some residents are assessed to be safe with their smoking paraphernalia. The same general rule appears to apply to the ability of people who live in the home to manage their own movements, money or medication. The general rule seems to be that they are not able, though some individuals are assessed as being able. While those who live in the home go out, such outings are usually with staff or in groups. Going out alone is often considered too risky, given the nature of the condition and the history of the client. Insufficient evidence was seen to demonstrate that risk assessments that may restrict individual resident’s freedom and ability to make decisions had been discussed with and agreed by the residents concerned on an individual basis or that the risk assessments are regularly reviewed to ensure that any restrictions are removed if there is no longer a risk to the individual concerned. During a return visit to the home in the early evening all residents we saw were already in pyjamas and dressing gown at 17.30. A member of staff told us that all those who live in the home were in pyjamas and dressing gown, and that this was the residents’ own choice. The manager subsequently corrected the member of staff, in that several residents choose not to dress in pyjamas and dressing gown until much later. While this practice of many of those who live at the home may not be a rule of the house, many observers would consider such behaviour to resemble institutional practice and / or a means of restraint. The registered persons must continue to modernise individual’s needs assessment, risk assessment and care planning processes to become more person centred rather than service led. This will help to ensure that the people who use the service are able to exercise more control over their lives and regain their independent living skills. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home are given good encouragement to retain their interests and aspirations and develop an interest in new activities and lifestyles, in particular to take regular exercise. They are encouraged and enabled to retain and regain contact with their families. The menu plans now include choice and healthy options. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment: “We have been able to promote a better healthy lifestyle for each resident then they had, because up until the time they came to us Alcohol played a vital part of the their life and this means that some residents did not have any lifestyle at all before admission to Vanehill, so by encouraging better dress sense, self discipline, self motivation, self control,we also encourage each resident to reduce or abstain from the intake of alcohol this will also help them to take Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 14 more pride in themselves, and enable them to take better care of themselves when they return to the community. We encourage keep fit in our small gym and the residents are given plenty of opportunity to go on walks and trips, and holidays in lodges and caravans and tented camping accomodation and this is done in large and smaller groups with staff suport. We also encourage residents families to accept their loved ones home with them for holidays and this works out very well and gives the residents families a chance to see how well their loved one has improved since being admitted to Vanehill, this has worked very well indeed and more families are taking advantage of the valuble time with their loved ones.” As part of the inspection process we looked at the files of four people who live at the home, toured the building, spoke to the manager and staff, spoke to all residents who were at home at the time of the inspection, and undertook surveys of people who live at the home. The weekly activity plan for people who live at the home were usually pinned up in their bedrooms. These provide an aide-memoir for those whose short term memories are very poor, and a structure for those who need external organisation of their daily lives. Together with discussions with the manager and those who live at the home themselves, these verify that activities recorded on individual plans include unpaid work, attendance at a day centre and long walks, including across Dartmoor. In-house social activities include weight training (there is a small Gym in the garden), snooker, pool, reading, doing jigsaws, watching television, drawing and computer games. Records and lots of photographs throughout the home showed evidence of group leisure activities. People who live at the home spoke enthusiastically about the holiday they recently enjoyed in a caravan park in Teignmouth. Transport is provided by the home’s own minibus which unnecessarily displays that the home is owned by Notaro specialist homes and so unfortunately stigmatises the occupants as care home residents. Records corroborated what people who live at the home told us that they were able to maintain or retain contact with their friends and families, and indeed, with their own identity. Owing to their background, the histories of some of the people who live at the home are scant. One or two do not even know their own true name or date of birth. We saw evidence of the manager’s efforts to obtain a birth certificate, background information and such as photographs of people who live at the home. Many people who live at the home display photos of themselves and their families in their bedrooms. We spoke to all those who live at the home. All feedback was positive. Several told us that they had improved considerably while they have been living here. Not only had they abstained from alcohol but their physical health had improved greatly, demonstrated by the long walks. Their self-esteem had also improved, and many have acquired work habits, skills and qualifications with certificates to equip them to eventually return to the community. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 15 The Registered Manager and Deputy Manager have recently attended a training course in nutrition. The menus now show a choice of meal with some healthy options. The food was sampled during the inspection and found to be well cooked and tasty and several residents said that they enjoyed the meals provided. One of the deputy managers and two of the people who live at the home share the responsibilities for cooking meals. Other people who live at the home accompany the manager to the cash-and-carry so that they can help choose ingredient for the meals and also to give them an awareness of the price of goods, albeit usually on a bulk basis, as part of a programme of reenablement. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The health needs of people who live at the home are well met by the care staff and / or through timely referrals to the primary and specialist health care services. They are kept safe by the home’s medication policies and practices and are able to take control of their own medication within a risk assessment framework and with support as necessary. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment: “We support individuals with very complex needs, and addictions, in a way that enables them to make a uniformed decision to abstain or reduce from intake of thier addition, and we also support the problems associated with brain damage caused from their addiction, we also carry out a complete health check to enable oral health, physical health, and mental health needs are to be met in full, this process is caried out in the first two weeks of a resident coming into care so we can spot any problems before the start from a health point of view.” Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 17 The home has for many years specialised in supporting people with Korsakoff’s Syndrome. Virtually none of the people who live at the home need much support with their personal care needs in terms of hands-on care such as washing, dressing, feeding or assistance with toileting. The home is not suitable for those with mobility problems, although there is a passenger lift at number 15. The home can and does cater for people who have a sensory loss. Individual care plans contained details of both routine and specialist healthcare treatments. Correspondence was seen in files concerning specialist appointments regarding the treatment of longer term physical and mental health needs. Other documents were seen relating to routine dental and eye care. Two or three people who live at the home administer their own medication. Each of these had a current risk assessment and a secure place to store their medicines. All people who live at the home have a lockable cupboard to store medications and valuables. The medicines administration records and records of receipts and returns appeared up-to-date and in good order. The Registered Manager stated that no controlled drugs were currently in use though appropriate secure storage was available. The home also has a medications fridge for storing medication that requires refrigeration. The use of homely remedies was supported by a medically approved list. All staff who have responsibility for the administration of medication have received appropriate training. Information about the medicines used is kept available at the home so that the staff and service users can be made aware what the various medicines are used for and of any possible side effects that they need to look out for. Records seen and conservations with people who live at the home confirmed that the home helps them to arrange appointments with chiropodists, a specialist dentist, opticians and GP’s. Unfortunately the manager has not yet received much support from the local teams specialising respectively in people with mental health problems and alcohol abuse. The manager told us that as people who live at the home have a mental health problem because of their alcohol abuse, each team feels the other is the more appropriate to take the case, the client therefore “falling between two stools”. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home are protected from the risk of abuse by the home’s policies and procedures and staff training. The complaints procedure and independent advocacy are accessible to people who live at the home. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment: “We have started to look at each individual better and are now recording all types of complaints, and acting on them.” The home has a complaints procedure and this is accessible to residents and visitors to the home. The home now keeps a record of complaints, but so far complaints from people who live in the home are about the behaviour of other people who live in the home, rather than about the home. The registered manager said that no complaints had been received about the service provided at the home. The staff are required to sign a record sheet stating that they have read and understood the contents of these and other policy documents. The registered manager has qualified as a trainer to provide training on the protection of vulnerable adults and said that he had provided training for all of his staff. All seven people who live at the home, and the four staff who completed a written survey stated that they knew who they would speak to if they were not Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 19 happy. Most people who live at the home felt that staff always listened to and acted upon their comments and two stated that this was usually the case. None of the five relatives / friends who returned their survey had made a complaint. We had a meeting with four staff. It was clear that they had a good understanding of the issue of abuse and knew what to do should they identify abusive practice or receive an allegation of abuse. The home has a key worker system which enables people who live at the home to consult with an individual member of staff. There are also regular recorded meetings at which people who live at the home can air their views. The home subscribes to the CareAware Advocacy Service so that people who live at the home can obtain professional and independent advocacy at no cost to themselves whenever they need it. Although some people who live at the home manage part of their own money, the vast majority of all monies of all people who live at the home are kept in a single “Vane Hill Client Account” at a high street bank. Individuals are identified on that account by their National Insurance Number. We saw how the manager meticulously keeps an account of everyone’s transactions on a programme on the office computer, which is linked in real time with the computer at the company’s head office. We saw how people who live at the home have easy access to their money by way of a small petty cash amount held in a safe. Records were kept detailing expenditure and receipts were retained for reference. We additionally spoke with the accountant at head office and with colleague inspectors who have inspected other homes of the company. We will give further consideration to this system. Whilst it would normally be preferable for each person who lives in a care home to have his or her own individual bank account which he or she manages by themselves, the system this home operates appears secure with a beneficial outcome for people who live in the home. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Vane Hill have a sufficiently well-maintained, clean, safe and hygienic, though not homely, environment. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment: “We provide a safe and comfortable environment for all our residents and try to make it a family atmosphere for each resident by encouragement, help and safety.” Vane Hill Care Home is made up of two houses that are opposite each other at the end of the cul-de-sac of Vane Hill. Both houses are grand properties with magnificent views across the town and sea of Torbay. The home is not served by a local bus service but the walk from the home to the town centre, beach and harbour is easy and should be accomplished in less than ten minutes. The return journey will take longer because it is uphill. The home benefits from Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 21 having two minibuses so transport can be provided for the residents if necessary. We toured both houses. Each has spacious communal rooms. Maintenance is ongoing with new windows in some of the rooms, and a new conservatory in which those who smoke can now do lawfully under cover. There is a mix of single and double bedrooms, few of which have en-suite facilities. The manager said that that the sharing of rooms can be beneficial to the client group catered for at Vane Hill. This may be the case, and may be acceptable in the short term but this is not good practice for homes providing long term care and consideration could be given to reducing the number of double rooms and providing en-suite facilities. The home was seen to be clean, adequately furnished and adequately decorated throughout. While the home meets the needs of those who live there, much of the furniture and décor is identical in each bedroom. While functional, many of the items of furniture were old fashioned, apparently quite old, and gave the ambience of an institution rather than a home. The institutional appearance of much of the home is exemplified by the huge window in the tiny office of the manager. Whilst this window offers light into the office, and reduces its claustrophobic effects, it inevitably becomes a position where one can observe people who live in the home without being seen oneself. Many of the walls in the downstairs are full of notices. The new minibus is identified as belonging to Notaro Specialist Homes. While individually, the furniture, furnishings, window, notices and signwriting on the minibus may appear irrelevant, and certainly not intended to evidence institutionalism, collectively they contribute to the ambience of an institution. In turn, this ambience may influence practices which are service led rather than being person centred, as indicated elsewhere in this report. The laundry facilities, which are in an outbuilding at the back of the house were seen to be clean, well equipped and suitable for their purpose. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 345, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff recruitment practices are safe and the residents can be confident that unsuitable staff will not be employed in the home. Staff training has improved, and the home is now an Investor in People. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment: “We have already a highly trained and motivated staff team,A Manager trained in RMA,NVQ 4, Dip. Drug & Alcohol Studies,Dip. Social Work Studies, Dip. Psychiatric Studies, Counselling Cert,POVA Trainer, amounst other certificates, also the staff on top of basic training Fire,Health Hygiene, Handling Lifting,Med management,Infection Control, Hearing Awareness, Learning Difficulty Trg, and also 75 Nvq 2, 25 Nvq 3. 4 staff have been trained in Nutrition Awareness in Care Homes. We have also been awarded this year investor in people award.” Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 23 The files of four staff revealed a safe recruitment process including criminal records checks (CRB), checks of the national list of unsuitable staff (POVA) and the taking up of two references. There was recorded evidence of regular staff supervision which focussed on people who live at the home needs and identified individual staff training needs. It was evident from observations during the inspection that the staff enjoy a good relationship with individuals and the group as a whole. The staff turnover at Vane Hill is very low. The staff files also contained evidence that annual appraisals are being carried out and that staff had received induction and on-going training. The records of training provided for the staff in health and safety related areas is good. This now includes specialised training to enable the staff to gain a better understanding of the specialist needs of the service users and to update their care practices. The manager is adept in sourcing training and training materials which he can himself use to train his staff and issue qualifications, in such diverse areas as Food Hygiene to the new Mental Capacity Act. Perhaps uniquely, most staff are trained as oxygen administrators to be able to use the kits easily accessible in both houses. Staff told us that they have successfully used these kits, which probably saved the life of a person who lives in the home. Nine of the thirteen care staff are already qualified to NVQ Level 2 or above. Another is working towards this. When qualified, this represents 77 qualified staff, well above the target of 50 . Achieving the Investor in People award provides authoritative evidence of good staffing practices. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well-managed and run in the best interests of the people who live there. The registered manager is qualified and experienced. A quality assurance system is being developed and the premises are safely maintained. EVIDENCE: The registered manager writes in the Annual Quality Assurance Assessment: “The Manager has gained qulifications over and above what C.S.C.I require for a Registered Manager which means that not only has he gained NVQ 4 and RMA ,but he is also a POVA Trainer and a Holistic counsellor, Diploma in Psychiatric Studies and a Diploma in Drug & Alcohol addiction studies, and a Diploma in Social work Studies and other first aid and Ambulance qulifications Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 25 from his past employment as a Trained Ambulance professinal. The Manager also ensures that the day to day operation of the home meet the written aims and objectives of the home, and that policies and procedures are implemented and that the homes day to day buget is properly managed and that we display the certificates required and that they are up to date,we also make sure that care plans and contracts and policies are up to date and reviewed regulary.We have also attained the investor in people award which means that the Manager has shown that he and the staff are getting the proper training for the job they do and that they are kept up to date with future training and refesher training.” People who live at the home benefit from the ethos, leadership and management approach of the registered manager and his support team at the company’s headquarters. In many respects the ambience of the home, the skills of the staff and the care practices reflect the curriculum vitae of the registered manager, who has served in the military, in the ambulance service and many years in residential care of vulnerable people. The registered manager lists some of his qualifications and skills above, including the necessary Registered Managers Award an NVQ in Care at Level 4. He also has an NEBBS qualification in supervisory management. In addition to this he has attended several certificated health and safety related training courses in alcohol dependency and mental illness. He is qualified to provide training on the Protection of Vulnerable Adults. Health and Safety related policies, procedures and training are in place and kept accessible to the staff. A system of Quality Assurance is being introduced into the home, including the use of surveys similar to those CSCI uses - to people who live in the home, staff, relatives and professionals in contact with the home. In addition, formal meetings of people who live in the home are held every six months. The registered manager said that informal staff meeting are held almost daily at the start of the staff’s working day. We took the opportunity during the inspection to use that staff grouping to ask them about their knowledge of Korsakoff’s Syndrome, their care practices, training and values. Combined with surveys some staff had completed and their personnel files, we were able to judge that staff are well motivated and trained and do a good job supporting people who live at the home. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 13 & 16 Requirement The registered persons must continue to modernise individual’s needs assessment, risk assessment and care planning processes to become more person centred rather than service led. This will help to ensure that the people who use the service are able to exercise more control over their lives and regain their independent living skills. Timescale for action 15/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations Although the home meets the environmental standards, consideration could be given to enhancing the privacy and dignity of people who live in the home. For example, by reducing the number of double bedrooms and providing more en-suite bath and/or shower rooms in line with the DS0000018445.V344618.R01.S.doc Version 5.2 Page 28 Vane Hill current standards for newly built accommodation and best practice. Vane Hill DS0000018445.V344618.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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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