Care Home: Vera James House

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What the care home does well This is a well run home where residents` individual needs are met and where well-trained and supported staff look them after. We received many positive comments from residents and their visitors including: `overall the care team are of a high standard`: `I can see no area that the care home does not do well. The staff are friendly, professional and efficient`; `I am very happy living here and am given prompt attention` and `the home provides a warm and caring environment very successfully. I can`t speak highly enough of the staff` Staff moral is good resulting in an enthusiastic workforce who work well with residents. Activities are varied and frequent and offer residents real stimulation and entertainment. One relative told us: ` the home offers mother plenty of entertainment so she has something to look forward to`. The home consistently reviews aspects of its performance through a variety of ways that include seeking the views of residents and their relatives, with good evidence that their views are taken seriously and acted upon. The health, safety and welfare of residents and staff are well promoted and protected. What has improved since the last inspection? Staffing levels on the dementia unit have improved with two staff now on duty throughout the day giving residents more individualised attention and supervision. Better signage and orientation aids have been provided around the home to help residents and visitors find their way around What the care home could do better: Care plans for all residents must be comprehensive and set out in detail the action which needs to be taken by care staff to ensure that all aspects of their health, personal, cultural and social care needs are met. The newly designed garden for the dementia care unit is a welcome addition to the home but more could be done to make this a genuinely interesting and stimulating place for residents. Familiar objects such as a green house, washing line, a vegetable patch or even a car could be included so that it resembles the garden of a domestic setting and also give residents the opportunity to hang out washing, weed, clean the car, sweep the patio etc. A covered area should also be provided so that residents can access this area even when it`s raining. All night staff must practice fire drills so they know what to do in the event of the alarm sounding. CARE HOMES FOR OLDER PEOPLE Vera James House Chapel Street Ely Cambridgeshire CB6 1TA Lead Inspector Janie Buchanan Unannounced Inspection 16th September 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vera James House Address Chapel Street Ely Cambridgeshire CB6 1TA 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) 01353 661113 01353 661829 verajames@cambridgehs.org.uk Cambridge Housing Society Ltd Mrs Susan Jill Gooch Care Home 39 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (39) of places Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th August 2006 Brief Description of the Service: Vera James House provides a service for a maximum of thirty-nine people over the age of 65, including a separate unit for up to eight older people with dementia. They also provide a respite care facility. All rooms provide en-suite facilities and are appropriately furnished and decorated. The property is situated within a larger complex belonging to the Cambridgeshire Housing Society, which includes sheltered housing. Weekly charges vary between £435 and £585, depending on residents’ needs. A copy of the home’s most recent inspection report form the Commission for Social Care Inspection is available in the entranceway to the home. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. For this inspection we (the CSCI) visited the home and talked with five residents, three members of staff and an assistant manager. We undertook a tour of the building, checked medication storage and recording, and viewed a range of documents. We also received information from the home’s annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. We received 24 completed surveys prior to our inspection from residents, their families and staff at the home. This is an excellent response rate and showed us that the manager takes inspection, and the feedback from people using the service, seriously. What the service does well: What has improved since the last inspection? Staffing levels on the dementia unit have improved with two staff now on duty throughout the day giving residents more individualised attention and supervision. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 6 Better signage and orientation aids have been provided around the home to help residents and visitors find their way around 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. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5, Quality in this outcome area is good. Comprehensive information is available about the home to help residents decide if it is where they want to live and new residents receive a thorough assessment of their care needs before admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Statement of Purpose and Service User Guide that give good information about the home and the services it offers. One resident told us she sent for a brochure about the home and liked the look of it from that alone. Prospective residents are encouraged to visit the home to assess its facilities, meet staff and stay for lunch and the same resident told us she came for a two week respite stay specifically to ‘try the home out’. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 9 New residents are only admitted on the basis of a full assessment and the residents’ files checked contained good pre-admission information about their individual needs. All residents are issued with a licence agreement which clearly states the terms and conditions of their stay, the fees payable and their responsibilities. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Residents’ health is closely monitored by staff and they have good access to a range of health care professionals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We checked the care plans for three residents. Two of the plans were satisfactory with residents’ needs in relation to their personal care, mobility, continence, diet, mental capacity and hobbies clearly recorded, with the action to be taken by staff to address the needs. There was evidence that the plans had been reviewed regularly and that residents and their relatives had contributed to planning their care. One relative told us: ‘after meeting with the management team a care plan was discussed which has worked very well for mum’. However the information in the third plan was poor and did not give enough detail to ensure that the resident received consistent care by staff. In addition to this, important information about this resident’s social history, life history and religious and cultural needs had not been completed. The home monitors residents’ health needs and their weights, dependency levels, nutritional and falls risk are regularly assessed. There was evidence in Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 11 the plans that residents saw a range of health care professionals and a district nurse visits three times a week. One resident who had suffered a number of falls was referred to a GP and a falls assessment quickly implemented. We talked to two visitors who relatives were being cared for in bed full time. They told us the care provided by staff was excellent. Another told us: ‘every effort is made by staff to meet the individual needs of each resident to promote good physical, mental and emotional lifestyles’ The home has recently signed up to the Department of Health’s ‘Dignity in Care’ campaign and is recruiting staff to become dignity champions. Most interactions we observed between staff and residents were respectful, positive and encouraging. However, during lunch one resident stated three times that she did not like sausages. Despite this, she was still served toad in the hole, with no real attempt by staff to offer her an alternative dish. This was a poor piece of care, where the resident’s wishes were clearly ignored, resulting in her leaving most of her lunch. We checked a sample of residents’ medical administration records. These were satisfactory bar a few minor errors that we discussed with the member of staff administering the medications. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. Social activities are well managed and provide good stimulation and interest for people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a busy and varied activities schedule, with something organised for residents to do most days. One relative commented; ‘ I hope that the varied social activities at Vera James will continue as my mother really looks forward to these events.’ On the day we visited a member of staff was hosting a quiz on the dementia unit. This member of staff was very skilled at including all the residents and took her time to repeat each question several times and ask each resident for their answer in turn. Residents were clearly enjoying themselves and there was much laughter and singing as a result. There are also frequent trips outside the home including recent trips to Hunstanton, Denny Abby, Woodgreen animal shelter, garden centres and Duxford Airport. We counted a total of 8 outings in the last 3 months: this is excellent and offers residents a real escape from the everyday humdrum of residential living. Staff at the home are currently involved in a project with Ely Cathedral and the Folk museum which will provide residents with a series of reminiscence sessions. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 13 Routines are flexible and one resident told us: ‘its not at all regimented here, it’s almost like being at home’. Another, ‘staff leave to sleep in if I’ve had a bad night’. However one resident told us she would like to have a bath more that once a week and wasn’t sure if that was possible. We took lunch with residents that consisted of toad in the hole or vegetable bake with green beans and cauliflower, followed by strawberry mouse. The food was tasty and well presented. One resident reported ‘over this year the food has improved a lot- more varied menus-i.e. Chicken Kiev, spaghetti Bolognese, sweet and sour chicken and noodles. Teas are much improved, I think largely due to new menus suggested by residents downstairs’. However could wish for LESS sandwiches- 3 days per week too much’. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is excellent. Residents have access to a robust effective complaints procedure, and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both residents and families who completed our surveys told us they knew how to make a complaint, and would feel confident about doing so. The complaints procedure is on display around the home and one relative told us: ‘ any concerns on either side (Vera James or the residents or myself) have been dealt with immediately, thoroughly and professionally’. Another reported; ‘the management team are always available if we have any concerns at all’ The home has received three formal complaints since the last inspection concerning poor laundering of clothes, a member of staff speaking rudely to a resident and an allegation of lack of activity in the home. All these complaints were taken seriously by the manager and investigated thoroughly using the home’s complaints procedure, with feedback given to the complainant about action taken. One of the assistant mangers has undertaken the key practitioner course in adult protection and showed good knowledge and understanding of this important issue. Two senior staff have also attended the 2-day management responsibilities course. Information about elder abuse and key contact names numbers is available in the home’s foyer and on the main office door so that people can easily access it. The home responded quickly and professionally to an allegation made against one of its staff, suspending them whilst an investigation took place. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 26 Quality in this outcome area is good. Residents live in a safe and wellmaintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents live in a well-maintained environment, which provides aids and equipment to meet their needs. The home was well lit, clean and smelled fresh on the day we visited. Each of the three living units has access to a garden, giving residents easy access to light and fresh air. However, one relative commented: ‘It would be nice for the residents to have a more inviting garden to encourage greater use by residents and staff’. The layout of the home consists of long, similar looking corridors between the units, however some orientation aids have been put up since the last inspection to help residents navigate their way around the building. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 16 There has been one outbreak of diarrhoea and vomiting since the last inspection and a number of infection control measures have been implemented as a result: hand sanitizers are now available in all bedrooms and toilets, as well as in the entranceway to the home. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. Residents receive their care from welltrained staff in sufficient numbers to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are seven care staff on between 8am and 2.30pm, and six care staff on between 2.30pm and 9.30pm to meet the needs of 39 residents. Three staff are on duty at night. Residents we spoke to told us that there were staff available when needed and they rarely waited a long time for help. A number of permanent staff have been on long term sick or maternity leave resulting in the home relying on agency staff to cover shifts. However there was no evidence that this was adversely affecting the care delivered to residents. Staff told us they had received training that was relevant to their role and kept them up to date with new ways of working. We viewed training records that showed that staff receive a wide range of training specific to the needs of older people including continence promotion, dementia care and care planning. 77 of staff have an NVQ level 2 in care or above which is well above the recommended standard. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 18 Staff we interviewed told us that their recruitment was fair and that adequate checks had been completed before they started working at the home. Unfortunately it was not possible to check personnel files on this occasion as they are held at Cambridge Housing Society’s head office, however we will check them at a later date. However, evidence from previous inspections shows that the home has had a robust recruitment procedure that protects residents. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is excellent. Residents live in a well run home, where their views count and their health and safety is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has the required qualifications and experience and is very competent to run the home. She sent us the home’s annual quality assurance assessment (AQAA) that was detailed and gave us all the information we asked for. It showed us that she knew what the home did well and what further improvements were needed. Staff described their morale as good, and told us they were well supported by the management team. We checked the files for three staff and the quality of their supervision meetings was excellent. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 20 The home actively seeks feedback about its performance and there are regular and meaningful meetings held with both residents and their families. At the last families’ meeting 24 people attended. At the last residents’ meeting 20 people attended to discuss issues such as the food, activities, fire procedures and new staff. Questionnaires are also regularly sent to residents, their families and health and social care professionals. 25 people completed the last survey (this is an excellent response rate) with most rating the quality of care, friendliness of staff and décor of home as good or excellent. A senior manager from Cambridge Housing Society also visits every month to check on the standards of care being provided. We receive copies of these reports that are always detailed, with shortfalls identified and addressed quickly. Families told us that the management team were responsive and helpful. One commented: ‘Management always available to discuss any issues you may have’. Another; ‘I just go to the office and things always get sorted’. The home holds cash for some residents: we checked the paperwork for this that showed that all transactions were clearly recorded and receipts kept. The home’s health and safety policies and risk assessments are comprehensive, with a range of activities undertaken by both residents and staff clearly assessed to reduce the risk of harm or accidents happening. However it was not clear if all night staff had regularly practised a fire drill. Regular checks of the home’s equipment are also undertaken to ensure their safety and effectiveness. A recent inspection of the home’s kitchen from the environmental health officer stated there were ‘excellent standards throughout’. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 4 3 2 x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 4 x 3 4 x 4 Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must contain comprehensive information about people’s needs so that staff can provide consistent care All night staff must undertake fire drills so they know what to do in the event of the fire alarm sounding Timescale for action 01/11/08 2 OP38 23 (4)(e) 01/11/08 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 OP20 Good Practice Recommendations The home’s garden area should be made more welcoming and suitable to the needs of residents. Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Vera James House DS0000015109.V371002.R01.S.doc Version 5.2 Page 24 - 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. 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