Care Home: Vansett Nursing Home

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well Vansett Nursing Home offers a comfortable, homely and friendly environment for residents to enjoy. Under the new owners, the premises is gradually being refurbished and residents will benefit by brighter decoration and upgraded facilities. Residents are assessed before they move to the home and trial visits, and respite stays, can be arranged. A local authority manager was very complimentary about two residents he had placed at this home. He thought the home and staff had done well to meet their needs and enable them to keep up with activities and interests these residents had enjoyed before moving to Vansett. Care plans contain the relevant risk assessments to enable staff to care properly for residents; the manager is currently working on a summary of each persons care plan which will be put in a folder in their room. Residents are offered a home cooked meal in pleasant surroundings at lunchtime. Those residents spoken with said the food was good. The last visit by the environmental health officer noted that the home had good systems in place and all legal requirements were being met at the time of the inspection. Staff were observed to interact well with residents and were respectful towards them. Those who needed assistance at lunchtime were given support in a sensitive manner. Despite being quite busy at times, staff are still trying to support residents with some activities until a replacement activities co-ordinator can be appointed. The Expert by Experience summed up the impression we got about the staff at this home: `The staff at Vansett seem very willing and able to meet the needs of residents and it was nice to spend some time in a home where the atmosphere and the approach of the staff appeared both warm and caring.` What has improved since the last inspection? This is the first inspection of this service under the new owners. What the care home could do better: Two Requirements were made at this inspection. The first concerned recruitment files which need to be checked to make sure they contain all the information required by the Regulations. The second concerned the new owners needing to carry out monthly unannounced visits to the home, and a written report will need to be kept. Though the owners currently visit the home frequently, from now on they will also need to do one formal, unannounced Regulation 26 visit per month. Six Recommendations were also made and these can be found at the end of this report. Key inspection report Care homes for older people Name: Address: Vansett Nursing Home 27-29 Norfolk Road Maidenhead Berkshire SL6 7AU     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: Helen Dickens     Date: 0 9 1 1 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 31 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 31 Information about the care home Name of care home: Address: Vansett Nursing Home 27-29 Norfolk Road Maidenhead Berkshire SL6 7AU . Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Purushotum Naraindutt Neehaul & Mrs Bibi Nazmoon Neehaul Name of registered manager (if applicable) Miss Khabo Johanna Mahlangu Type of registration: Number of places registered: care home 22 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 who can be accommodated is: 22 The registered person may provide the following category/ies of service only: Care home with Nursing N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Vansett Nursing Home is situated in a quiet residential road in Maidenhead, and is made up of two Victorian three storey semi-detached properties. The home has been operating for some years but is now under new ownership. There is a garden to the rear of the property and limited off street parking to the front. The home and the garden are undergoing a planned programme of refurbishment by the new owners. Care Homes for Older People Page 4 of 31 0 Over 65 22 Brief description of the care home There is disabled access to the front and rear of the property, and the home has a shaft lift which reaches all three floors. Current fees range from £580; for more information about fees, please contact the home. Care Homes for Older People Page 5 of 31 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: This unannounced inspection took place over 8 hours and was carried out by Mrs. Helen Dickens, Regulation Inspector. Miss Johanna Mahlangu, Registered Manager, represented the establishment. One of the new owners, Mrs. Neehaul, joined the inspection briefly in the morning, and Mr. Neehaul, spoke with the Inspector by telephone following the inspection. A number of files and records were sampled during the inspection, including four residents files, and two staff recruitment and training files. The Annual Quality Assurance Assessment, submitted to the Commission by the manager, was used to plan this inspection, and an number of surveys returned from service users and other stakeholders were also taken into account. The Inspector was accompanied by an Expert by Experience who spent three hours at the home speaking with residents, staff and the manager, and making observations Care Homes for Older People Page 6 of 31 which were then forwarded to the inspector as a written summary of the visit. This summary has also been used in writing this report. The Inspector and the Expert by Experience would like to thank the manager, staff, residents and visitors for their time, assistance and hospitality throughout this inspection. Care Homes for Older People Page 7 of 31 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. Care Homes for Older People Page 8 of 31 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users have the information they need to make an informed choice about where to live, and service users have a contract with their terms and conditions of stay at the home. No service user moves into this home without having their needs assessed and been assured these will be met. Trial visits are encouraged so that prospective service users have the opportunity to assess the facilities. Evidence: The Annual Quality Assurance Assessment (AQAA) states that they have up-dated their Statement of Purpose and Service User Guide, and that they carry out a thorough pre-admission assessment by senior staff to ensure that needs are identified prior to admission. The home is now using the Berkshire Care Association (BCA) recommended assessment format for all new clients. The AQAA also stated that service users all have a contract. Four residents files were sampled during this inspection, one being for the most Care Homes for Older People Page 11 of 31 Evidence: recently admitted resident. This file contained the new BCA admission format being used together with the homes own assessment documents. One set of admission documents would have been easier to navigate, but all the necessary information was recorded on one form or the other. Trial visits are available to potential service users, and the home currently has several regular respite residents who may eventually decide to move into the home on a permanent basis. The manager said one person had recently come as a temporary resident whilst they had their name down for another home, but then when it was time to move, they said they preferred to stay at Vansett. Surveys returned from two health professionals showed that they thought proper assessment arrangements were in place. Three service user surveys showed they had enough information prior to moving in, and had been given a contract. A telephone interview with a local authority manager following this inspection showed that they were pleased with the arrangements the home had put in place to meet the specialist needs of two particular service users. Care Homes for Older People Page 12 of 31 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. Each resident has a care plan which sets out their nursing and care needs, and their social and health care needs are met. Medication arrangements protect service users, and they are treated with dignity and respect. Evidence: The AQAA states that the home uses a person centred planning approach and works in partnership with relatives. People are given the opportunity to manage their own health care. Care plans and risk assessments are in place to identify those at risk of pressure areas, and nutritional risk assessments are done. Four care plans were seen during the inspection and were found to contain the relevant information on nursing and care needs. Risk assessments, for example in relation to skin care, nutrition, bed rails, moving and handling and falls were also seen. Several people who had been admitted with pressure ulcers had care plans and separate nursing records about how these were to be managed. The manager outlined the positive progress made by one such resident since that person had moved to Vansett. The manager has an audit tool which she uses to review care plans. Care Homes for Older People Page 13 of 31 Evidence: The manager was asked to review residents care plans as inconsistencies in how they were set out meant that some information, whilst recorded, was not always easy to find. The manager said she is compiling a summary of each persons care plan to put in their room, which should make things more straight forward for care staff who support people with their personal care. Some care plans also needed more detailed information on exactly how residents would like their support to be given. Whilst the manager was able to give a detailed account, that level of detail was not written down for care staff. Residents can choose their own GP when they move into Vansett. The home works with other community health professionals for the benefit of residents, and evidence of specialist assessments was noted for example from the tissue viability nurse and the community physiotherapist. A health professional who visited the home on the day of the inspection said that on the few occasions they had visited the home they had always been made to feel welcome by staff, and that staff followed the advice given to them about the support they needed to give each particular resident. Health needs are monitored and the manager demonstrated this with for example, the weekly audit of those at risk, or already having, pressure ulcers. Surveys returned from two health professionals ticked always and usually to the question about whether social and health care needs of residents are monitored and met, and to the question regarding whether staff sought advice when needed. Both respondents ticked always to the question about whether the home then responded appropriately. Medication comes from the local pharmacy with pre-printed medication administration records and the NOMAD system for storing medication. Records were well kept and those records sampled for the last three weeks, for two different residents, showed there were no unexplained gaps on the records. The manager said only trained nurses give medication though care workers may be needed to check medication with a trained nurse at night, so those care workers have medication training as well. Below is an extract from the report written by the Expert by Experience, following her visit to Vansett Nursing Home. She has commented on several of the Standards in this section, including Privacy and Dignity. The staff at Vansett seem very willing and able to meet the needs of residents and it was nice to spend some time in a home where the atmosphere and the approach of the staff appeared both warm and caring. Care Homes for Older People Page 14 of 31 Evidence: During lunch I observed those residents that needed assistance being given it in a very polite, unhurried, respectful way. One gentleman dropped his drink all over the floor but was immediately re-assured by a member of staff that it was OK and not a problem and that she would bring him another immediately which she did. It was nice to see such a caring, relaxed approach and I am sure the gentleman concerned benefited from being made to feel that he had not caused a problem. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have limited opportunities for stimulating activities and to be part of the local community, though this should improve when an activities co-ordinator is appointed. They do however have the chance to exercise some choice and control over their lives, and at mealtimes they are offered homemade food and a pleasant dining experience. Evidence: The AQAA states that they have more activities than before and have continued to keep a good relationship with the local community. The new owners were actively involved in the barbecue and met with service users and relatives. At the inspection it was noted that there is currently no activities organiser and the manager said they are now recruiting a new one. On the surveys returned from residents, one service user said there are always activities in which they can participate, and the other two residents ticked usually. The same response was given regarding the suitability of meals. The manager said care staff were trying to keep up with activities for residents until a new person is appointed and she outlined examples of the current activities and Care Homes for Older People Page 16 of 31 Evidence: interests at the home. One resident attends a dancing club, and another goes to Brunel Day Services. A service manager from the local Borough Council said they had been very pleased that one of the residents placed by them had been supported by the staff to keep up with the activities they had enjoyed before moving into the home, including arranging suitable transport. Some residents will be going on a garden centre outing coming up later this week, and five residents go to afternoon tea at the community centre once a month. A dog visits the home with their owner, and the home also has their own cat, Kalli, who was seen to be popular with residents and spent most of the day with them indoors. The Expert by Experience also had some comments to make on activities and the following is taken directly from her report: Whilst spending time in the lounge I did notice that the staff seemed very relaxed and interacted with the residents when passing by but at the same time I felt that they were quite busy. It became apparent that there was no activities co-ordinator and although some residents were given paper and paints the staff did not seem to have time to engage them in the activity. Residents were seen to be given choices in their day to day lives, for example in relation to what they would like to eat, where they would like to spend the day, and how they would like their personal support to be delivered. The Expert by Experience looked at the kitchen and dining room arrangements and had lunch with residents to get their opinions about the meals. The following is an excerpt from her report: I started my tour of the home with the kitchen which was, as pointed out, a more open plan arrangement and it is possible to see the chef at work when sitting in the dining area. The kitchen is divided from the dining area by a waist high work surface which has an access door that is usually closed, thereby preventing residents from being able to walk into the kitchen area. The majority of residents are not independently mobile and therefore are seemingly not at risk of wandering into the kitchen. The menus operate on a six week revolving menu and having looked at the selections available I found them to be healthy and varied. The chef advised me that he would do my very best to accommodate any requests. The choices for the day of the visit were chicken drumsticks, vegetables and mashed potatoes, or macaroni cheese. Care Homes for Older People Page 17 of 31 Evidence: Comments from residents included ...very happy and well cared for, and the food is good. During discussions with the chef he confirmed that at least one of the two options each lunchtime is homemade. The home welcomes back friends or relatives of past residents, and one such visitor made some complimentary remarks in a survey returned to CQC. She wrote: I visited the home nearly every day and my relative was very well taken care of by all the staff, who were always patient, friendly and endeavoured to help her in every way. Another person who used to visit their relative now visits the home daily and chats with residents over lunch. Care Homes for Older People Page 18 of 31 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. Residents complaints would be listened to and taken seriously, and there are policies and procedures in place which should protect them from abuse. Evidence: Vansett Nursing Home has a complaints procedure in place and a copy is displayed in the entrance hallway. Service user surveys returned to CQC showed that residents would know who to talk to if they had a concern, but two out of three said they did not know how to make a formal complaint. The manager was asked to think about how to remind residents and visitors about the existence of the formal complaints procedure. The manager keeps a record of complaints and this was seen during the inspection. No complaints have been made to the Commission since the home was registered with the new owners six months ago. A relative who spoke with the Expert by Experience said they had had reason to make a complaint some months ago and that the matter was dealt with. She said she had great confidence in the manager and would not hesitate to complain if she felt it was necessary. The manager said there were no outstanding complaints at the time of the inspection. There is a safeguarding adults procedure in place and staff have had training in this subject. The manager has also had Mental Capacity Act and Deprivation of Liberty Safeguards training. No safeguarding adults issues have been reported since the home was registered with the new owners. The manager was clear about her responsibility Care Homes for Older People Page 19 of 31 Evidence: to report any suspected abuse to the local authority, however the homes own policy needs to be revised as it indicates that the manager would investigate any allegations of abuse. The policy should dovetail with the local authoritys policy, and the manager was asked to contact them for advice and to get some leaflets which could be given to staff as a summary of the arrangements for reporting safeguarding matters. Care Homes for Older People Page 20 of 31 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. Vansett Nursing Home offers a homely environment which will benefit by the programme of refurbishment planned by the new owners. The home was found to be clean and hygienic throughout. Evidence: Staff work hard to create a homely environment and it was noted that bedrooms are personalised and the communal areas are comfortable and clean. The new owners recognise that some refurbishment is needed and have already started work in both the home and the garden. The front lounge has been redecorated and carpet replaced. The Expert by Experience noticed there was a tear in the other lounge carpet, but the manager said a replacement carpet had already been ordered. One bedroom room has been decorated, and a new carpet and vanity unit have been fitted. The AQAA stated that the clock machine in the front entrance has been removed, and air fresheners installed. The manager said that service users and their families are remarking positively on the changes. It was noted that there are several notices around the home which detract from the homely ambiance that the manager and staff are trying to create. The manager was asked to think about whether some of these notices might be more appropriately placed. Care Homes for Older People Page 21 of 31 Evidence: It was noted on the day of the inspection that there was a problem with a shortage of storage space at Vansett Nursing Home. The home is not purpose built, and, whilst the old property adds a homely character to the premises, it also presents some difficulties for staff and residents. Wheelchairs were being stored in the downstairs hallway, there were vacuum cleaners and weighing scales at the bottom of the stairs, and a hoist left by the front door. The top floor corridor was lined on one side with clothes storage boxes, neatly hidden by a curtain, but nevertheless may have posed a risk in the event of fire. The manager was asked to review storage arrangements and to get advice about the storage of the wheelchairs and clothes in relation to their fire safety arrangements. Following the inspection the manager rang to say the owner had arranged for a visit to the home by a fire safety adviser and a builder, to look at how to improve their storage and fire safety arrangements. This manager rang back to confirm this visit took place in the same week as the inspection. The homes fire risk assessment will now need to be up-dated. The AQAA says there is an action plan in place to deliver best practice in infection control. During the inspection the home was found to be clean and fresh with no unpleasant odours in any part of the home. There are good hand washing facilities throughout and now hand gel has been placed near the signing in book to encourage visitors to use this. The laundry was visited and was found to have a commercial washing machine and a separate drier, and there is a dedicated member of staff who looks after the laundry arrangements. She should commended for the way she manages the laundry arrangements, in a fairly small space, yet keeps the area clean, tidy and fresh. She outlined how she ensured residents always had their own clothes returned to them, and there were no complaints regarding clothes being lost. Service users who returned surveys to the Commission ticked that the home was either always or usually, fresh and clean. The Expert by Experience noted in her report that one of the residents told her that the laundry works really well. Care Homes for Older People Page 22 of 31 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. Residents needs are met by the numbers and skill mix of staff at Vansett Nursing Home. More work needs to be done on recruitment administration to fully safeguard service users. Residents will benefit by the proposed improvements in training arrangements at this home. Evidence: The staffing numbers and the skill mix of qualified to unqualified staff was appropriate on the day of the inspection. There are two trained nurses on duty during the day and one each night, supported by four care workers during the day, and one care worker at night. There are separate cleaning and laundry staff, and a chef, so care staff have limited domestic tasks in their day to day work. In addition to the qualified nurses, the AQAA states that 50 of the care staff at this home have at least an NVQ Level 2 in care work. The surveys returned to the Commission showed that residents said staff were always available when they needed them. Observations on the day of the inspection made by and to the Expert by Experience showed that whilst staff were busy at times, Residents were very pleased with the staff...and I had observed them being able to meet the needs of the residents in a calm, reassuring way. The AQAA states that they carry out various recruitment checks when taking on new Care Homes for Older People Page 23 of 31 Evidence: staff. Two recruitment files were checked and both had application forms, Criminal Records Bureau and POVA List checks, two references, photographic identification, and evidence that both were allowed to work in the UK. However, one had a large gap in their employment history and there was no record that this had been followed up. Both recruits had two references but one did not have a reference from their last care employer, and the other had a reference from a work colleague, rather that the actual care employer they had worked for. The manager said she would be able to get the missing employment history by the next day and would follow up on the references. A copy of the latest version of Schedule 2, from the Care Homes Regulations was given to the manager, and this sets out all the information that should be sought and then made available for inspection. The staff files sampled showed staff had had an appropriate induction and training, though there is currently no central training record. The manager said the new owners are working towards this. There was evidence that staff were attending relevant training courses and the manager had three such courses booked for herself before Christmas. Care Homes for Older People Page 24 of 31 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. Vansett Nursing home is well managed and service users benefit by the ethos and leadership approach of the current manager. A number of quality assurance processes are in place, though more work is needed to ensure any shortfalls in service provision are identified and dealt with in a timely way. Residents financial interests are safeguarded at this home, and there are satisfactory arrangements in place for the supervision of staff. There are some good examples of health and safety practise, though further improvements would benefit residents. Evidence: The manager has been in post prior to the recent change in ownership and has managed the home since 2007. Before her appointment she had held management positions in other care settings. On the day of the inspection she said she was in the last stages of completing the registered managers award. The manager had a very positive attitude to the inspection process and during the inspection she was seen to lead by example in the professional yet caring way she dealt with residents, staff and visitors. One visitor told the Expert by Experience that she had Great confidence in Care Homes for Older People Page 25 of 31 Evidence: the manager. The new owners were not aware that they needed to complete a monthly Regulation 26 report on the home. These reports must be completed where a provider does not have day to day charge of the home. Whilst they directly manage their other home, and therefore Regulation 26 visits are not required, at Vansett a registered manager has been appointed for the day to day management. Mr. Neehaul apologised for his oversight and said he would complete his first report for November. He was directed to the CQC website where a Regulation 26 template is available. Residents and staff benefit by the ethos, leadership and management approach at this home. There was a friendly and warm atmosphere within the home and the manager demonstrated a hands on approach to her work. Staff files showed one to one sessions with the manager where she had given coaching sessions to them to improve their practice. The current quality assurance processes include annual surveys, and an ad hoc survey at the recent barbecue. Efforts have also been made to arrange relatives and residents meetings though their first attempt did not attract enough support from relatives. The manager demonstrated actions taken as a result of comments which were received. Other monitoring includes a care plan checklist, weekly pressure sore monitoring, and checking medication records. The new owners have identified areas for development and improvement including refurbishing the property and carrying out work in the garden. The home should review their current quality assurance arrangements to ensure they provide a comprehensive system for monitoring the quality of their service, and to make sure any shortfalls are identified and dealt with in a timely way. The manager said small amounts of money can be kept on behalf of service users and either the manager or her deputy deal with these transactions. Written records and receipts are kept. The new owner checks these records periodically. Both staff files checked showed that the new staff had had sufficient supervision sessions with the manager since starting work at Vansett Nursing Home. One had already had four sessions, and the other had had five sessions. This means they would be on course to receive more than the recommended six sessions per year as recommended in the National Minimum Standards. The manager was able to show where extra sessions had been required, and there were good records of observational supervisions she had carried out with staff. Care Homes for Older People Page 26 of 31 Evidence: A number of measures are in place to promote good health and safety within the home. Staff receive training on this and the manager said all but new staff have completed this already, with new staff booked on the training. Staff also have other relevant training including moving and handling training, and there are relevant risk assessments in place, for example for the use of bed rails. She said she highlights the importance of health and safety at hand overs, and discusses any outstanding issues with staff. Some examples of good practise were seen, for example the manager ensures new visitors are made aware of fire exits within the home, and the inspector was shown these on arrival. The home also has good arrangements for ad hoc repairs including health and safety problems, in that the new owner employs a maintenance worker for their two homes. On the day of the inspection the worker was in the home looking at a problem with a piece of equipment. He was then able to carry out some minor safety measures identified during the inspection as noted below A number of shortfalls were found on the day of the inspection including the upstairs office and bathroom window where window restrictors had not been fitted. The risk would be minimal as most residents are not independently mobile. However, the manager arranged for window restrictors to be fitted immediately by the maintenance worker. Also, one bathroom had a liquid air freshener and a small amount of bubble bath in the cupboard. These may have posed a hazard if swallowed. Though the risk was minimal given no residents on that floor can use the bathroom independently, the manager agreed that these should not have been left in the bathroom and removed them immediately. It is recommended that the health and safety monitoring arrangements are reviewed, as part of the quality assurance review, to ensure issues such as those noted during the inspection are identified and dealt with in a timely way. Care Homes for Older People Page 27 of 31 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 28 of 31 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 28 19 Recruitment records for staff 09/12/2009 must contain all the information set out in Schedule 2 of the Care Homes Regulations 2001 (as amended), and this information must be available for inspection. For the safety and welfare of service users. 2 31 26 Where the registered provider is not in day to day charge of the home, a monthly unannounced visit must be made to the home and a written report made. For the welfare of service users, and to check the quality of the service being provided. 30/11/2009 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should be reviewed to ensure there is sufficient detail about how residents would like their support to be delivered, and to make it easier for care staff to access the information they need. It is recommended that activities arrangements are reviewed to ensure people at Vansett Nursing Home have the opportunity to participate in stimulating activities on a more consistent and regular basis. The manager was asked to contact the local authority for advice on Vansetts current Safeguarding Adults Policy. It is recommended that the home takes advice on the current storage arrangements, and any impact this may have on fire safety. It is recommended that there is a central staff training record showing staff training to date, and when their refresher courses are due. The home should review their current quality assurance arrangements (including their health and safety monitoring) to ensure they provide a comprehensive system for monitoring the quality of their service, and to make sure any shortfalls are identified and dealt with in a timely way. 2 12 3 4 18 19 5 30 6 33 Care Homes for Older People Page 30 of 31 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. 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!