Care Home: Vicarage House

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What the care home does well Vicarage House provides a homely environment for the people living there. Appropriately trained registered nurses are on duty over a 24hr period. The home ensures that nobody moves to the home unless they have been fully assessed by the manager or deputy manager. Each person has an up to date plan of care, which is developed from appropriate assessments. We were able to see evidence that people using the service and/or their representatives had been involved in the care planning process. People spoken with told us that their needs were met at the home and all commented on the kindness of staff. The home ensures that people have access to a range of appropriate healthcare professionals and that their health care needs are monitored. The home follows safe procedures for the management and administration of peoples` medication. The home obtains information about an individual`s preferences during their final days and following death so that their needs and wishes are met. The registered manager informed us that they have close links with hospices both in Taunton and Yeovil and that they follow the `Liverpool Care Pathway`. This framework is a continous quality improvement framework for care of the dying irrespective of diagnosis or place of death. People told us that they knew how to make a complaint and that they would feel confident in raising concerns. The home has policies and procedures in place to reduce the risk of harm or abuse to people living at the home. Staff told us that they were aware of how to raise concerns. The standard of cleanliness is good and the home follows the correct procedures to reduce the risk of the spread of infection. The home is managed by an experienced registered manager who is a registered general nurse. In comment cards, we asked staff and relatives/carers, `What do you feel the home does well?` and the following comments were raised; `Good level of care from all staff`, `I feel people are well cared for`, `Provides a good homely atmosphere` What has improved since the last inspection? N/A What the care home could do better: Many parts of the home appeared `tired` and are in need of refurbishment and redecoration. Since taking over the home in late 2007, the new owners have commenced a programme of redecoration and refurbishment which is currently on-going. Although staff told us that they felt well supported, the home need to introduce formal recording tools for staff supervisions and need to ensure that staff receive supervision at least six times a year. We found two freestanding wardrobes which had not been secured to the wall and one window above ground floor level that did not have a restricted opening. Given that people currently living at the home are not mobile, the registered manager did not feel that people were at immediate risk. It has been required that appropriate action is taken within the agreed timescale to ensure the safety of all persons using the service. CARE HOMES FOR OLDER PEOPLE Vicarage House The Old Vicarage Hambridge Langport Somerset TA10 0BG Lead Inspector Kathy McCluskey Key Unannounced Inspection 09:30 2 September 2008 nd 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 Vicarage House DS0000071002.V363466.R02.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. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vicarage House Address The Old Vicarage Hambridge Langport Somerset TA10 0BG 01460 281670 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) Southwest Care Ltd Mrs Susan Margaret McCallum Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 23. Date of last inspection Brief Description of the Service: Vicarage House is situated in the small rural village of Hambridge, which is approximately three miles from the town of Langport. The home is situated in its own grounds and accommodation is arranged over three floors, which are serviced by a passenger lift. The main house can accommodate up to 21 people. Within the grounds is a bungalow, which can accommodate two people who are mainly self-caring and do not require nursing care. Vicarage House is registered with the Commission for Social Care Inspection to provide general nursing care. The home is not registered to accommodate people who require care for their dementia. We were provided with information which identified the home’s current fee levels as £650 per week. People using the service meet the cost of additional items such as; newspapers, hairdressing, private chiropody and person items Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service for each outcome group under four general headings. These are; - excellent, good, adequate and poor. This unannounced key inspection was conducted over one day (8hrs) by CSCI Regulation Inspector Kathy McCluskey. The registered manager was available throughout this inspection. We were informed that at the time of this inspection, 19 people were living at the home. We were able to speak with a number of people using the service and three staff. We were given unrestricted access to the home and records required for this inspection were made available to us. As part of this key inspection the Commission sent comment cards to a random selection of people living at the home, staff, relatives and healthcare professionals. Completed comment cards were received from 3 staff, 4 relatives/carers and 2 people using the service. Comments have been included in the report as appropriate. The home returned its’ completed Annual Quality Assurance Assessment (AQAA) to the Commission within the required timescale. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Extracts from the AQAA have been included in the report as appropriate. We would like to thank all involved, for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 6 What the service does well: Vicarage House provides a homely environment for the people living there. Appropriately trained registered nurses are on duty over a 24hr period. The home ensures that nobody moves to the home unless they have been fully assessed by the manager or deputy manager. Each person has an up to date plan of care, which is developed from appropriate assessments. We were able to see evidence that people using the service and/or their representatives had been involved in the care planning process. People spoken with told us that their needs were met at the home and all commented on the kindness of staff. The home ensures that people have access to a range of appropriate healthcare professionals and that their health care needs are monitored. The home follows safe procedures for the management and administration of peoples’ medication. The home obtains information about an individual’s preferences during their final days and following death so that their needs and wishes are met. The registered manager informed us that they have close links with hospices both in Taunton and Yeovil and that they follow the ‘Liverpool Care Pathway’. This framework is a continous quality improvement framework for care of the dying irrespective of diagnosis or place of death. People told us that they knew how to make a complaint and that they would feel confident in raising concerns. The home has policies and procedures in place to reduce the risk of harm or abuse to people living at the home. Staff told us that they were aware of how to raise concerns. The standard of cleanliness is good and the home follows the correct procedures to reduce the risk of the spread of infection. The home is managed by an experienced registered manager who is a registered general nurse. In comment cards, we asked staff and relatives/carers, ‘What do you feel the home does well?’ and the following comments were raised; ‘Good level of care from all staff’, ‘I feel people are well cared for’, ‘Provides a good homely atmosphere’ Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 7 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. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 8 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 Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 9 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, 3 & 5. Standard 6 is not applicable as the home is not registered for intermediate care. Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. People thinking about using the service are provided with the information they need to enable them to make an informed decision about moving to the home. The home ensures that anybody thinking about moving to the home is appropriately assessed to ensure that an individuals needs and aspirations can be met. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide, which provide information about the home and services offered. These documents were submitted to the Commission at the point of registration on 14th Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 10 December 2007. As there have been no changes, these documents were not examined at this inspection. Two people using the service completed comment cards for the Commission and both confirmed that they had received enough information about the home before they decided to move in. We examined three care plans and were able to see evidence that the home had fully assessed each person before a placement was offered. Assessments had also been obtained from other healthcare professionals as appropriate. The registered manager confirmed that a placement at the home would not be offered unless they were confident that an individual’s needs and aspirations could be met. The home’s Statement of Purpose states that the first month of occupancy is considered a trial period thus enabling the individual and the home to be sure that all assessed needs and aspirations can be met. The home also offers a respite facility. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 11 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 & 11 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home’s care planning procedures ensure that individuals’ assessed needs can be met. The home ensures that peoples’ healthcare needs are met and that people have access to appropriate healthcare professionals. EVIDENCE: Each person has a plan of care which is developed from a range of assessments. We viewed three care plans at this inspection all of which were up to date and reflective of the individuals assessed needs. Appropriate assessments were in place which included nutrition, moving and handling, prevention of pressure sores and oral health. We were able to see that care plans had been reviewed at least monthly and that the individual and/or their representative had been involved in the care planning process. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 12 Registered nurses and care staff complete detailed ‘daily records’ for each individual at the end of every shift. The registered manager confirmed excellent links and support from the local GP surgery and informed us that the GP visits the home on a weekly basis. People at the home also have access to ophthalmic, hearing and dental services. The home maintains records within the plan of care, relating to individuals contact with healthcare professionals. Peoples’ weights are monitored on a monthly basis and we were able to see that a plan of care is implemented where concerns are highlighted. The registered manager advised us that there was currently nobody who had developed pressure sores at the home. We were shown records relating to four people who were being treated for pressure sores which were already in place on admission. Photographic evidence of the progress of sores evidenced that the pressure sores were healing. The home maintains records relating to the management of pressure sores though it has been recommended that all information pertaining to the management of pressure sores, is collated and maintained within one area/file as it was difficult to locate and track progress of the wound. During this inspection we spoke in depth with approximately eight people using the service. All told us that the home was able to meet their needs and that the care was ‘good’. All commented on the kindness of staff. Two people using the service completed comment cards for the Commission and in response to the question; ‘Do you receive the care and support you need?’, both responded ‘Always’ and both confirmed that staff ‘listened and acted’ on what they said. Four relatives confirmed that the home was meeting the needs of their relative. Three staff members completed comment cards for the Commission and in response to the question; ‘Are you given up to date information about the needs of the people you care for’, 3 responded ‘Always’ and 1 ‘usually’ During the inspection we spoke with two members of staff who both confirmed that people living at the home received ‘Good care’. We examined the home’s procedures for the management and administration of peoples’ medication. Medication Administration Records (MAR) are developed by the home using information from the individuals’ prescriptions. Entries are confirmed by two signatures to reduce the risk of any errors. A photograph of each person is attached to their MAR chart to aid identification. Appropriate records are maintained for all medicines received into the home or disposed of. We were able to see evidence that the home follows the correct procedures relating to controlled drugs. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 13 All medication was found to be appropriately stored with no excess stocks apparent. Medicines are only administered by the registered nurse on duty. People told us that staff at the home treat them with respect. During this inspection we observed staff knocking on peoples bedroom doors before entering and people were referred to in their preferred form of address. The home obtains information about an individual’s preferences during their final days and following death so that their needs and wishes are met. The registered manager informed us that they have close links with hospices both in Taunton and Yeovil and that they follow the ‘Liverpool Care Pathway’. This framework is a continous quality improvement framework for care of the dying irrespective of diagnosis or place of death. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 14 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 good This judgement has been made using available evidence including a visit to this service. A programme of activities is available for those who wish to join in. All meals are freshly prepared and cooked at the home by catering staff and special diets are catered for. EVIDENCE: The home employs an activity co-ordinator who works two afternoons a week. A programme of activities is displayed for people and once a fortnight an outside entertainer provides ‘musical’ afternoons. The home aims to obtain a social history from each person and/or their representative soon after they move to the home. Information is recorded in the plan of care. The registered manager informed us that as people living at the home have become more frail, there is less interest in planned activities. We were informed that there were plans to increase care staff hours during the afternoons to enable more ‘one to one’ time with individuals. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 15 We spoke to a number of people living at the home and the majority indicated that they choose not to join in with planned activities. The activity co-ordinator currently only records details relating to each activity that has been offered. We have recommended that records are maintained for each individual which also detail the outcome for the person i.e. did the person enjoy the activity. People told us that their relatives could visit at any reasonable time and that they were made to feel welcome. Visitors have access to tea and coffee making facilities in one of the lounge areas. We did not meet with any visitors at this inspection. People living at the home told us that they were able to make choices about their lives. They told us that they could choose when to get up in the morning and when to go to bed. They said that they made choices about how to spend their day and with regard to meals offered. During this inspection we were able to see lunch being served. This appeared plentiful and appetising and care had been taken to ensure that soft diets had been attractively presented. A cook is on duty covering a 7-day period and all meals are freshly prepared in the home’s kitchen. We were informed that the kitchen is due for major refurbishment. The kitchens were inspected by the Environmental Health Department earlier this year and no concerns or recommendations were raised. When we asked people living at the home about the food, they told us; ‘The meals are very good’, ‘Always plenty to eat’, ‘You can’t fault the food, it is very good’. As previously mentioned in this report, the home completes nutritional assessments for each person, weights are regularly monitored and care plans are raised where there is an assessed need. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 16 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 Good This judgement has been made using available evidence including a visit to this service. People feel confident in raising concerns though the home’s complaints procedure needs to be updated. The home has policies and procedures in place to reduce the risk of harm or abuse to people using the service. EVIDENCE: The home displays a complaints procedure though this needs updating to reflect the change in ownership, name of home and change in the Commission’s contact details. The complaints procedure should clearly identify the procedure for people to follow and should also identify a 28-day time scale. On examination of the home’s complaints records, we were able to see that the home had received one complaint since being registered. This was fully investigated by the environmental health department and was found to be unsubstantiated. We asked people living at the home if they knew how to make a complaint and they told us that they would not hesitate in raising concerns if they had any. No concerns were raised with us at this inspection by staff or by people using the service. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 17 No complaints have been raised directly with the Commission since the home was registered. The home has procedures in place to reduce the risk of harm or abuse to the people living there. Newly appointed staff do not commence employment until the home have received all required information including an enhanced criminal record check (CRB) and check against the Protection of Vulnerable Adults register (POVA). The home has policies for staff relating to ‘whistle blowing’, acceptance of gifts, restraint and abuse. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. A programme of refurbishment and redecoration has commenced with further works planned. Many parts of the home still require attention. The standard of cleanliness is good and procedures are in place to reduce the risk of the spread of infection. EVIDENCE: Since taking over the home in December 2007, the new registered providers have commenced a programme of redecoration and refurbishment. Works are on-going as many parts of the home are ‘tired’ looking and need attention. Once completed, this will have a positive outcome for people living at the home. The registered providers demonstrated their commitment to improving Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 19 the standards of the environment during the process of registration with the Commission. Given that works are on-going, not all standards were assessed at this inspection and progress will be followed up at the next inspection. Procedures are followed to ensure that the home complies with local fire and environmental health standards. The home employs domestic staff covering a 7-day period. At the time of this inspection all areas of the home viewed were clean and free from malodours. Two people living at the home completed comment cards for the Commission and in response to the question, ‘Is the home fresh and clean?’ both responded ‘Always’. We were able to see that staff hand washing facilities were appropriately sited throughout the home and that staff had access to a good supply of protective equipment and sanitising gels. The registered manager informed us that there was nobody at the home with an acquired infection. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 20 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 This judgement has been made using available evidence including a visit to this service. People are cared for by adequate numbers of staff that have the skills and training to meet individuals’ needs. The home follows procedures for the recruitment of staff, which reduce the risk of harm or abuse to the people living there. EVIDENCE: We were informed that 19 people were currently living at the home and that the bungalow was not currently being utilised. The registered manager informed us that minimum staffing levels were as follows; Morning – 1 registered general nurse and 4 care staff Afternoon – 1 registered general nurse and 2 care staff This increases to 3 care staff from 1630hrs. Night – 1 registered nurse and 1 carer, both waking. The registered manager stated that there were plans to increase the number of care staff by one in the afternoons. The registered manager also indicated that staffing levels would be increased as necessary to ensure that they remained appropriate to the dependency levels of the people living there. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 21 The registered manager, who is a first level registered nurse, works five days a week and is in addition to the care hours. In addition to nursing/care staff, the home employs catering staff, domestics and an activities co-ordinator. We were informed that during the holiday period, the home has used some agency staff to cover shortfalls. The home currently has no staff vacancies. People spoken with at the inspection told us that their needs were met by staff ‘day or night’. Staff were heard communicating with people in a kind and respectful manner and staff were observed responding to call bells promptly. Three staff members completed comment cards for the Commission and in response to the question; ‘Are there enough staff to meet the individual needs of all the people that use the service’ all responded ‘Usually’. Staff spoken with during the inspection did not raise any concerns about staffing levels or of their ability to meet peoples’ needs. The home’s completed AQAA told us that of the 16 permanent care staff employed, 5 had achieved a minimum of an NVQ level 2 in Care. This equates to 31 , which falls below the recommended 50 of the National Minimum Standards. The AQAA told us that there were currently 2 care staff working towards this award. There was evidence that registered nurses regularly attended updates and training sessions appropriate to their role. All staff have received mandatory training and the registered manager informed us that there are plans to provide further training for care staff. We examined two staff recruitment files at this inspection and were able to see evidence that staff had not commenced employment until the receipt of two satisfactory references and checks from the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults register (POVA). It has been recommended that the home reviews its current application for employment so that it prompts applicants to provide at least 10 years employment history with start and finish dates so that any gaps in employment can be identified and explored. On commencement of employment, staff undertake the home’s basic induction programme before they go on to follow the Skills for Care Common Induction Programme. One newly appointed member of staff confirmed that they had received a satisfactory period of induction. This was also confirmed in the three comment cards received from staff members. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 22 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 Good This judgement has been made using available evidence including a visit to this service. The home is effectively managed. The home has procedures in place to seek the views of people living there. Formal systems need to be introduced to ensure that staff are appropriately supervised. The home’s procedures relating to health and safety are generally good. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 23 EVIDENCE: The registered manager is Mrs Sue McCallum and she is a first level registered general nurse. Mrs McCallum has been at the home since 1991 and remained in post following the change of ownership in 2007. Although the registered manager is in addition to the nursing staff on duty, it was apparent during this inspection that she is very much ‘hands on’. Through discussion it was apparent that she had a very in-depth knowledge as to the needs of the people living at the home. People told us that they found her ‘approachable’ and ‘helpful’. The home has quality assurance procedures in place. Quality questionnaires are sent out to people living at the home and their relatives/representatives. We were able to see a selection of completed questionnaires that had been returned in July of this year. Although the number of questionnaires returned was low, responses to questions were positive. The registered manager informed us that formal meetings for people living at the home were not currently appropriate given their needs. Formal meetings are held for all staff on a regular basis. Minutes of the most recent staff meetings were made available to us. The registered manager informed us that the directors visited the home frequently and that they were ‘very supportive’. Reports completed by the responsible individual, in accordance with regulation 26 of the Care Homes Regulations 2001, were not available at the home as required. This was discussed with one of the directors who confirmed that these would be maintained at the home in future. We were able to see evidence that all staff receive an annual appraisal. There was no documented evidence that staff received formal supervision at least six times a year. The registered manager informed us that she met regularly with all staff where various topics, including training needs, were discussed. The registered manager confirmed that she was not currently documenting issues discussed. Three staff members completed comment cards for the Commission and in response to the question; ‘Does your manager meet with you to give you support and discuss how you are working?’ two responded ‘Sometimes’ and one ‘often’. One indicated that they had ‘one meeting in three and a half years’. To ensure that all staff receive appropriate and regular supervision and support, it has been required that formal systems are introduced with records maintained. Staff should receive supervision sessions, which cover topics set out in the National Minimum Standards, at least six times a year. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 24 We examined some of the home’s procedures relating to health and safety and we also made a tour of the premises. Our findings were as follows; We were able to see evidence that annual servicing had been conducted on the home’s fire systems. The registered manager stated that the home had an up to date fire risk assessment. This document was not examined by the Commission. Six monthly servicing records were in place for the home’s mobile hoists and bath hoist. These were dated 19/08/08. We were informed that several engineer call outs had been conducted for the home’s passenger lift. Engineer reports were seen. A servicing certificate was not available and we were informed by one of the directors that arrangements had been made for the lift to be serviced the following week. During a tour of the premises we found two wardrobes, which had not been secured to the wall and one window on a second floor corridor that did not have a restricted opening. This was discussed with the registered manager who advised that people were not currently at risk given that none can mobilise independently. A requirement has been raised that appropriate action is taken within a given timescale. The registered manager stated that the temperatures of hot water outlets were checked at least monthly by one of the directors. It has been recommended that records of all checks are kept at the home. During the inspection we checked the temperature of the bath hot water outlet, which was found to be within safe upper limits. The registered manager informed us that all staff had received up to date training in moving and handling, fire safety and food hygiene and that all registered nurses had an up to date certificate in first aid. Documented evidence was seen though it has been recommended that the registered manager develops a matrix which would clearly identify dates and details of training for all staff as this would provide clearer information as to when updates for mandatory training were due. Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 25 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 “ ” 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 X 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? 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 OP36 Regulation 18(2) Requirement The registered person must make arrangements to ensure that all staff are appropriately supervised. Each staff member should receive supervision at least six times a year with records maintained. To ensure the safety of persons at the home, the registered person must ensure that windows above ground floor level are fitted with restricted openings and that all free standing wardrobes are secured to the wall. Timescale for action 10/10/08 2. OP38 13(4) 10/10/08 Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 27 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 OP8 Good Practice Recommendations To ensure that the progress of wound care can be easily ‘tracked’, the registered manager should consider consolidating all information pertaining to the management of wounds, in one area. Records relating to activities could be improved if individual records were maintained for each person, which also identified the outcome of the activity offered i.e. whether it was enjoyed by the individual. The home should aim for 50 of the permanent care staff having been trained to a minimum of an NVQ Level 2 in Care. The home’s application for employment form should be updated so that it requests applicants to provide a 10-year employment history to include dates commenced and dates of leaving employment. Records relating to checks on hot water outlets should be maintained at the home. The registered manager should consider developing a matrix which would clearly identify staff training needs and achievements. 2. OP12 3. 4. OP28 OP29 5. 6. OP38 OP38 Vicarage House DS0000071002.V363466.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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