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Care Home: Vicarage House Residential Home

  • 1 Honicknowle Lane Pennycross Plymouth Devon PL2 3QR
  • Tel: 01752779050
  • Fax: 01752779050
  • Planned feature Advertise here!

  • Latitude: 50.396999359131
    Longitude: -4.1500000953674
  • Manager: Manager post vacant
  • Price p/w: ~
  • UK
  • Total Capacity: 35
  • Type: Care home only
  • Provider: Dr Pepper`s Care Corporation Limited
  • Ownership: Private
  • Care Home ID: 17231
Residents Needs:
Old age, not falling within any other category, Physical disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 14th April 2010. CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

For extracts, read the latest CQC inspection for Vicarage House Residential Home.

What the care home does well Vicarage House is a clean, warm and comfortable home where people feel well looked after by staff who respect their privacy and dignity and are caring, polite, helpful and friendly. People who live in the home feel safe, respected, well cared for and happy. The manager is well liked and respected by the people living in the home, their relatives, and visiting professionals, who were very complimentary about her. Relatives and friends can visit whenever they like and feel welcomed by staff when they come into the home. People are enabled to maintain contact with family and friends, exercising as much choice and control over their lives as possible. The garden is landscaped and provides sitting areas for people that they are easily able to access. Staff enjoy working in the home, which is reflected in the low turnover of staff, and this contributes greatly to the provision of continuous and consistent care. Staff feel very well supported by the manager and they have various training opportunities available to them. All the staff have the skills and knowledge to provide good quality care to the people who live there and approximaely half of them have achieved formal qualifications in health and social care. Staff files are very well organised and information was easy to find. What has improved since the last inspection? The manager carries out assessments of people`s needs before they move into the home to make sure Vicarage House is suitable for them. The information about the home, such as the Statement of Purpose and Service User Guide, have been updated so people know what services and facilities are available in the home. Medication practices have improved in that controlled drugs are being regularly audited, eye drops are properly labelled with the name of the person for whom they have been prescribed as well as the date of opening. Medications are being stored correctly, a suitable cupboard for controlled drugs has been obtained as well as a thermometer for monitoring the temperature of the medications refrigerator. If people living in the home keep their own medication in their rooms, a record is kept in the office of what medication they have. The manager has also assessed, with that person, their ability to manage their own medicines and what precautions they need to take, such as making sure it is kept securely in their rooms. There is a written procedure for the handling of medicines in the home and a proper register is kept to record the receipt and disposal of controlled drugs. Care and support plans for each person now contain more information about people`s social activities, personal history and how other aspects of their lives are managed, such as money and mail. Staff are much more proactive in monitoring changes in people`s care and health needs and taking appropriate and immediate action. Recruitment practices have improved and all the required checks and references are obtained before new staff members start working in the home. New staff members (with little or no previous experience in care) are expected to complete induction training to ensure they have enough information to do their jobs. Staffing levels are kept under review to make sure there are enough staff on duty to meet the needs of the people who live in the home. Staff have completed training about how to make sure vulnerable people are kept safe, including fire safety, and what procedures they need to follow. They are also receiving training related to caring for older people to make sure they have the skills to provide good quality care. Staff have regular one to one meetings with their line manager, including observations of their practice, and staff meetings are also held. Equipment used by staff in the home, such as mobile hoists, have been serviced and a regular servicing programme is in place. More wheelchairs have been obtained so there is enough equipment in the home for people to use. Every bed has a pressure relieving mattress to reduce the risk of people developing pressure sores. All fire safety equipment is being checked regularly to make it is in the correct location and has not been tampered with or damaged. The electrical wiring system in the home has been checked by an external contractor to make sure it is safe. The temperature of hot food is being checked and documented to show that it is properly cooked. Some bedrooms have been refurbished, new carpets have been laid in the hallways and there is an ongoing redecoration programme in place. One room has been made into a smoking room for people to use if they wish to. The staff have arranged for people who live in the home to have regular trips out of the home so that people have opportunities to enjoy and pursue their social, cultural, religious and recreational interests in the wider community. The quality assurance system has been developed to include an annual internal audit of the facilities and services in the home to ensure that the aims, objectives and statement of purpose of the home are being met. What the care home could do better: The manager has now been in post for approximately 18 months and should apply to be registered with the Care Quality Commission to ensure that she is qualified, competent and experienced to run the home. The views about meals expressed by people who live in the home were mixed in that some people said they enjoyed the food and others did not. Therefore the menus and the quality of the food provided needs to be reviewed to ensure that people receive meals that are varied, appealing, wholesome and nutritious and are suited to individual requirements. It may be helpful therefore if the menu planning and choice of meals is agreed between the staff team and the people who live in the home. Records are not being kept of meals provided to people who live in the home and this information needs to be kept. This is because there should be information easily available to determine whether the diet is satisfactory, in relation to nutrition or any other reason, and to make sure that people receive varied meals in relation to any special diets. Whilst there is a medication procedure in the home it needs to include information about the process staff should follow for people who keep and administer their own medication. This is to make sure that all staff know what to do when people in the home self-administer medication. Whilst recruitment practices have improved there needs to be an audit trail of how the decision to employ a new staff member is made. This means that records should be kept of interviews when recruiting staff to work in the home, including any interviews in relation to criminal records. Application forms should contain a health declaration for prospective new staff to complete to confirm they are fit to work in a care home. To make sure people who live in the home are kept safe from harm, all the staff are expected to attend training about safeguarding vulnerable adults but they should also attend the training provided by the Local Authority. This is to make sure that each staff member is knowledgeable about the local procedures to follow should an incident of abuse or neglect be suspected or occur. Each staff member receives training in what to do in the event of a fire but there was no simple overview of who had completed the training and when. Therefore it would be useful if a system was put into place to provide this overall view to make sure that no staff are inadvertently missed out and that all staff receive regular updates. There are procedures in the home that staff follow to make sure that people who live there are not scalded by hot water when having a bath. However it is also advisable to fit a design solution, such as thermostatically controlled valves, to all hot water outlets accessible by the people who live in the home, including wash hand basins. This is to maintain the hot water at a safe temperature to ensure that people will not be scalded. Key inspection report Care homes for older people Name: Address: Vicarage House Residential Home 1 Honicknowle Lane Pennycross Plymouth Devon PL2 3QR     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: Antonia Reynolds     Date: 1 6 0 4 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Vicarage House Residential Home 1 Honicknowle Lane Pennycross Plymouth Devon PL2 3QR 01752779050 01752779050 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Pepper`s Care Corporation Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 35 The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability, aged 65 years or over on admission (Code PD(E)) Date of last inspection Brief description of the care home Vicarage House is a care home providing accommodation and personal care for a maximum of 35 people over the age of 65 who may also have physical disabilities. It is Care Homes for Older People Page 4 of 30 Over 65 35 35 0 0 Brief description of the care home privately owned by Dr Peppers Care Corporation Ltd that also owns another care home in Devon. In April 2010 the fee levels ranged from £330 to £380 per week but may vary depending on the individual needs of each person. Items not included in the fees include chiropody, hairdressing, newspapers, personal toiletries and public transport costs. The home is a detached, two storey property situated in the residential area of Pennycross. The home is within walking distance of local shops and close to bus services into central Plymouth and the railway station. There are 34 bedrooms in the home, 33 of which are single and one could be shared if people choose to do so. There are 24 bedrooms on the ground floor and 10 on the 1st floor, which can be accessed using a stair lift. The six bedrooms in the new extension all have en suite toilets. Communal rooms are on the ground floor and consist of two lounge rooms, linked by a sitting area containing a small library, and a dining room. There is also a designated smoking room for people to use. The home has a large garden with patio and decking areas that people can easily get to. There is parking space at the front of the house and on street parking is available nearby. Information about the home, including copies of inspection reports, can be obtained from the manager of the home. Care Homes for Older People Page 5 of 30 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 inspection consisted of an unannounced visit to the home by one inspector between 10.15am and 1.40pm on Wednesday, 14th April 2010 and a further visit between 10.45am and 2.20pm on Friday, 16th April 2010. The inspector was accompanied by an Expert by Experience on the first day. We completed our last key (full) inspection on 17th April 2009. An unannounced random inspection was carried out on 28th October 2009 to monitor compliance with the requirements made at the previous inspection. The findings from the random inspection are included in this report. Throughout this report, the term we will be used as the report is written on behalf of the Care Quality Commission. An Annual Quality Assurance Assessment (AQAA) was completed by the home prior to the inspection. The AQAA is a selfassessment that focusses on how well outcomes are met for the people who live in the home. A tour of the premises took place and records relating to care, staff and the home were Care Homes for Older People Page 6 of 30 inspected. Ten people living in the home were spoken with during the visit and ten surveys were returned from them, although some of these had been completed by relatives. Six visitors were spoken with during the visits. Four staff members were spoken with and nine surveys were received from staff. Three healthcare professionals were spoken with during the visit and two surveys were received from healthcare professionals. The Manager was available for consultation and discussion during the inspection process. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The manager carries out assessments of peoples needs before they move into the home to make sure Vicarage House is suitable for them. The information about the home, such as the Statement of Purpose and Service User Guide, have been updated so people know what services and facilities are available in the home. Medication practices have improved in that controlled drugs are being regularly audited, eye drops are properly labelled with the name of the person for whom they have been prescribed as well as the date of opening. Medications are being stored correctly, a suitable cupboard for controlled drugs has been obtained as well as a thermometer for monitoring the temperature of the medications refrigerator. If people living in the home keep their own medication in their rooms, a record is kept in the office of what medication they have. The manager has also assessed, with that person, their ability to manage their own medicines and what precautions they need to take, such as making sure it is kept securely in their rooms. There is a written procedure for the handling of medicines in the home and a proper register is kept to record the receipt and disposal of controlled drugs. Care and support plans for each person now contain more information about peoples social activities, personal history and how other aspects of their lives are managed, such as money and mail. Staff are much more proactive in monitoring changes in peoples care and health needs and taking appropriate and immediate action. Recruitment practices have improved and all the required checks and references are obtained before new staff members start working in the home. New staff members (with little or no previous experience in care) are expected to complete induction training to ensure they have enough information to do their jobs. Staffing levels are kept under review to make sure there are enough staff on duty to meet the needs of the people who live in the home. Staff have completed training about how to make Care Homes for Older People Page 8 of 30 sure vulnerable people are kept safe, including fire safety, and what procedures they need to follow. They are also receiving training related to caring for older people to make sure they have the skills to provide good quality care. Staff have regular one to one meetings with their line manager, including observations of their practice, and staff meetings are also held. Equipment used by staff in the home, such as mobile hoists, have been serviced and a regular servicing programme is in place. More wheelchairs have been obtained so there is enough equipment in the home for people to use. Every bed has a pressure relieving mattress to reduce the risk of people developing pressure sores. All fire safety equipment is being checked regularly to make it is in the correct location and has not been tampered with or damaged. The electrical wiring system in the home has been checked by an external contractor to make sure it is safe. The temperature of hot food is being checked and documented to show that it is properly cooked. Some bedrooms have been refurbished, new carpets have been laid in the hallways and there is an ongoing redecoration programme in place. One room has been made into a smoking room for people to use if they wish to. The staff have arranged for people who live in the home to have regular trips out of the home so that people have opportunities to enjoy and pursue their social, cultural, religious and recreational interests in the wider community. The quality assurance system has been developed to include an annual internal audit of the facilities and services in the home to ensure that the aims, objectives and statement of purpose of the home are being met. What they could do better: The manager has now been in post for approximately 18 months and should apply to be registered with the Care Quality Commission to ensure that she is qualified, competent and experienced to run the home. The views about meals expressed by people who live in the home were mixed in that some people said they enjoyed the food and others did not. Therefore the menus and the quality of the food provided needs to be reviewed to ensure that people receive meals that are varied, appealing, wholesome and nutritious and are suited to individual requirements. It may be helpful therefore if the menu planning and choice of meals is agreed between the staff team and the people who live in the home. Records are not being kept of meals provided to people who live in the home and this information needs to be kept. This is because there should be information easily available to determine whether the diet is satisfactory, in relation to nutrition or any other reason, and to make sure that people receive varied meals in relation to any special diets. Whilst there is a medication procedure in the home it needs to include information about the process staff should follow for people who keep and administer their own medication. This is to make sure that all staff know what to do when people in the home self-administer medication. Whilst recruitment practices have improved there needs to be an audit trail of how the decision to employ a new staff member is made. This means that records should be kept of interviews when recruiting staff to work in the home, including any interviews Care Homes for Older People Page 9 of 30 in relation to criminal records. Application forms should contain a health declaration for prospective new staff to complete to confirm they are fit to work in a care home. To make sure people who live in the home are kept safe from harm, all the staff are expected to attend training about safeguarding vulnerable adults but they should also attend the training provided by the Local Authority. This is to make sure that each staff member is knowledgeable about the local procedures to follow should an incident of abuse or neglect be suspected or occur. Each staff member receives training in what to do in the event of a fire but there was no simple overview of who had completed the training and when. Therefore it would be useful if a system was put into place to provide this overall view to make sure that no staff are inadvertently missed out and that all staff receive regular updates. There are procedures in the home that staff follow to make sure that people who live there are not scalded by hot water when having a bath. However it is also advisable to fit a design solution, such as thermostatically controlled valves, to all hot water outlets accessible by the people who live in the home, including wash hand basins. This is to maintain the hot water at a safe temperature to ensure that people will not be scalded. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 10 of 30 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 11 of 30 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. Pre-admission processes are in place to ensure that peoples needs are properly identified and planned for before they move into the home. Evidence: The home has a Statement of Purpose and a Service User Guide, called a Resident Information Pack, which describe the services provided at Vicarage House. These have recently been updated and information in surveys from people who live in the home confirmed that they were given information about the home, and had opportunities to visit, before they moved in. The manager said that, before people come to live in the home, a thorough initial assessment of their physical, psychological and social care needs is carried out to decide whether the home can meet them. The files of three people who had recently been admitted to the home were inspected and these contained pre-admission assessments of their needs. Surveys from staff members confirmed that they have enough information about peoples needs to provide the care required. The admission process includes visits to the home to meet the other people Care Homes for Older People Page 12 of 30 Evidence: who live there and staff, so that people have a chance to assess the quality, facilities and suitability of the home. Vicarage House does not provide intermediate care. Care Homes for Older People Page 13 of 30 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. People who live in the home are treated with respect and personal support is offered in a way that makes people feel safe, well cared for and promotes their privacy and dignity. There are arrangements in place to ensure that medication is administered in a safe way. Evidence: Those people spoken with, as well as surveys from people who live in the home and their relatives, confirmed that the staff provide personal care in a respectful way that preserves peoples privacy and dignity. Everyone spoken with praised the attention they receive from the staff. Staff were observed knocking on bedroom doors before entering and discussion with staff members showed that they respect peoples privacy. Whilst walking around the home we saw that the staff always make sure bedroom, bathroom and toilet doors are closed when people need assistance with personal care. Discussions with people living in the home, as well as the manager, confirmed that people can have their own telephone in their bedrooms, at their own expense, if they wish to. However the home has a telephone system with portable handsets and people can use this to make and receive private telephone calls. Comments in surveys Care Homes for Older People Page 14 of 30 Evidence: received from people who live in the home included: we are taken good care of; they care and look after me; and everyone is very helpful and caring. People who live in the home, surveys from relatives and staff, as well as information contained in personal files, confirmed that people living in the home have access to health care services such as doctors, district nurses, dentists, chiropodists, opticians and hospital consultants. Equipment to promote peoples health and well being is provided including equipment for promoting pressure area care and to prevent skin breakdown. The people who live in the home told the Expert by Experience that they see their doctor whenever they need to and, if required, receive regular attention from the District Nurses. One person said that the manager always calls the doctor right away when I need to see him. Information in surveys from two healthcare professionals said that peoples health care needs are usually met by the staff team. A visiting District Nurse who we spoke with said that the staff team always contact them when needed and follow their guidance/instructions about the care people need. The manager has also arranged for a dentist to visit people in the home on a regular basis and he was visiting on the last day of our inspection. The files of three people who lived in the home were inspected and these contained individual care plans, recently reviewed and updated, with information on care needs and how staff at the home would meet those needs. Peoples files contain the names and addresses of their relatives and representatives so that staff know whom to contact should they need to. Each file contained recently reviewed and updated risk assessments relating to falls, skin/pressure area care, moving and handling and, where required, the use of bed rails. Information about each person is recorded on a daily basis and any changes in needs are documented quickly so that staff coming on duty know what has occurred. The care plans contained brief information about peoples social and personal histories and previous lifestyles, interests and routines. However the manager said that this is being addressed and they have also asked relatives to participate in gathering more information together. All the people spoken with said that they choose their own times for getting up and going to bed. Discussions with the manager and a staff member showed that every person living in the home is asked if they would like a bath each day. These tend to be in the morning but people can have a bath in the evening if they prefer. The staff member spoken with considered this is an improvement as people can have as many baths as they like when they like, rather than having an allocated day, which is what used to happen. One person who lives in the home told the Expert by Experience that the same girl has bathed me each week for six years and she is really motherly although much younger than me of course! Care Homes for Older People Page 15 of 30 Evidence: Medication is stored securely and most of it is administered from blister packs prepared by a local pharmacist. Records relating to the administration of medication are up-to-date and there is an accurate audit trail of medication in and out of the home. People are supported to manage their own medication and risk assessments have been carried out to ensure that people are safe to do this. One person living in the home told the Expert by Experience that the manager always gets my prescriptions as soon as possible. There is a record kept in peoples files of what medication they have in their room. The home has a refrigerator specifically for storing medicines that need to be kept cold but there was nothing in it at the time of inspection. Inspection of the eye drops and creams held in the home confirmed that they should be kept at room temperature. Controlled drugs are kept in a cabinet specifically designed for this purpose and the receipt, administration and disposal of the controlled drugs is documented in a proper register designed for this purpose. The manager confirmed that staff who were responsible for administering medication have received training to ensure they are competent and confident to administer medication in a safe way. There is a documented procedure for staff to follow about the administration of medication and controlled drugs but this did not include the process for people who hold and administer their own medication. Care Homes for Older People Page 16 of 30 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. The routines in the home are relaxed and relatives and friends can be confident that they are welcomed. Social activities are arranged including the opportunity for trips outside the home. The dietary needs of people who live in the home are catered for although the quality and choice of meals does not always meet individual preferences. Evidence: The people who live in the home said that they are free to come and go as they wish. They are encouraged to maintain interests and friendships outside of the home and confirmed that friends and relatives are welcomed. Visitors in the home said that they are always made very welcome by the staff and feel that they can visit at any time. The home has a designated activities co-ordinator who works on three afternoons a week facilitating group activities such as craft work, quizzes and bingo. Most people spoken with said they joined in, although some people told us that they choose not to participate. The manager said that they are starting a system to monitor who participates in activities and who does not so that they can identify people who may need extra support. Outside entertainers visit on a regular basis and one person told the Expert by Experience that they enjoyed a visit by children who sang and danced. One person said he is collected by people from a local charity and taken for a Care Homes for Older People Page 17 of 30 Evidence: lunchtime meal twice a week and taken to the shops by an ex-neighbour on another day. Trips out of the home have taken place and more are planned. The manager said that these are partly funded by the staff organising money raising events with the balance being paid for by those taking the trips. Two visitors told us that their relative has thoroughly enjoyed the trips out that she has been on. A minister of religion visits the home regularly and people can participate in a communion service if they wished to. The staff know which people usually attend and there is a list of those people kept in the office so staff know whom to remind about the visit. The manager said that, if people wish to attend a place of religious worship outside the home, they wil be supported to do so by staff from the home, relatives or volunteers from the church or other place of religious observance. People who live in the home told the Expert by Experience that they can choose whether to eat in the dining room, the lounge room or their bedrooms. Small tables have been purchased so that more people can exercise this choice if they want to. The menu for the day is usually written on a white board outside the dining room but was a couple of days out of date on the first day of inspection but has been updated by the second day of inspection. There is a set meal each day and a member of staff tells each person what is planned for the next day so that they can choose an alternative if they want one. Alternatives include jacket potatoes, ham and/or egg and chips, sausages or sandwiches. Comments made to the Expert by Experience about the food varied from brilliant and very good to alright I suppose. People living in the home were realistic saying that they couldnt expect to like all the meals all the time. Information in surveys was also varied and responses about liking the meals were evenly distributed between always, usually and sometimes. Surveys from staff also said that there were not enough choices of meals for people over a period of time. On the first day of the inspection the lunch meal was sausages, mashed potato with mixed vegetables and gravy followed by tinned pears and chocolate mousse. Most people cleared their plates. Supper was to be a choice of soup, sandwiches or fish fingers, baked beans and potato waffles. Special diets, such as diabetic, are catered for and dietary needs are documented in peoples personal files. No records were kept of the meals provided to the people who live in the home and this should take place so that any nutritional needs can be properly monitored. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can be confident that any complaints or concerns will be listened to and acted upon by the staff and management team. Evidence: The home has a written complaints procedure and this was included in the Resident Information Pack. Discussions with people living in the home and their relatives, as well as information contained in surveys, confirmed that the staff and manager are very approachable and they have confidence in bringing any concerns to them. All the surveys we received from the people in the home and their relatives confirmed that they have no complaints about the home. The home keeps a complaints file where all concerns and complaints are recorded as well as the details of any investigation and actions required. The home has a visitors book to record dates, times and names of all visitors to the home. Some of the staff have received training related to the safeguarding of vulnerable adults and this is included in formal qualifications such as National Vocational Qualifications (NVQs). However staff have not attended the safeguarding training provided by the Local Authority therefore may not be aware of the local procedures to follow should an incident of abuse or neglect be suspected or alleged. Discussion with the manager confirmed that she is knowledgeable about the local processes in place to safeguard vulnerable people. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, comfortable and warm, providing people with a pleasant environment in which to live. Evidence: We looked all round the home (although did not go into every bedroom) and it was found to be warm, comfortable, clean and free from offensive odours. The shared rooms consist of a dining room, two lounge rooms adjacent to each other and linked with a sitting area containing a small library, and a smoking room. We saw that televisions were turned on in both the lounges and this means that there is no quiet area other than the dining room for those people who may wish to sit and talk to each other. One person in a survey commented that that there is no quiet place where people could talk and get to know each other. There is an ongoing programme of redecoration and refurbishment and new carpets were being laid in the hallway during this inspection. The bedrooms are located on the ground and 1st floors and there is a stair lift to the 1st floor. A survey from a relative said that the furniture in some of the bedrooms needs updating as the wardrobe and drawers fall apart and surveys from staff also said that the decor of the home could be improved. The manager said that the bedrooms are gradually being redecorated and the furniture replaced. The homes shaft lift has not worked since September 2007 and the manager said that there are no plans to repair or replace this. The home has one bedroom that could be shared if people choose to do so and all the other bedrooms are for single occupancy. The six Care Homes for Older People Page 20 of 30 Evidence: newer bedrooms all have en suite toilets. All bedroom doors are fitted with locks to protect peoples privacy and the security of their belongings and the manager said people are provided with keys if they want them. The bedrooms visited were well decorated, contained many personal possessions and people said they were comfortable in them. There is a call bell system throughout the home and these have been clearly marked in the lounge rooms so that people can see them easily should they need to use them. The laundry facilities are clean and spacious with sufficient equipment to meet the needs of the home. Whilst no-one specifically mentioned the quality of the laundry service, we saw that people were dressed in clean, ironed clothes. Arrangements are in place for controlling the spread of infection, such as liquid soap and paper towels in toilets and bathrooms, and all staff were seen wearing gloves and aprons that are regularly changed. Radiators are covered to prevent the risk of burns should a person come into contact with them when on. The manager confirmed that the hot water is not thermostatically controlled to prevent the risk of scalding. However we took the temperature of the hot water coming out of the taps in one bathroom and the water temperature was at a safe level (42 degrees centigrade). Also there are instructions for staff in each bathroom to follow to make sure that the hot water is at a safe temperature in the baths, bath thermometers are available to check this and the temperature of the water is documented. Discussion with a staff member assisting people to have baths confirmed that she was fully knowledgeable about the procedure to follow, always checks the temperature and knows what temperature is safe for people. Toilets and bathrooms are clean and bath hoists are available to assist people with restricted mobility. There is also one bathroom with a walk-in bath that people may use if they wish to. The manager said that equipment, such as wheelchairs, bath lifts and hoists has been serviced, repaired or replaced and there is documentation to show that servicing has taken place. The garden is landscaped to provide patio and decking areas that are easily accessible to most people living in the home. People with restricted mobility said that the staff assist them to go outside when the weather is nice. Care Homes for Older People Page 21 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of caring, trained staff support the people who live in the home. Recruitment practices protect the people who live in the home from risk of harm. Evidence: Information contained in staffing rotas, as well as discussion with the manager, showed that there are usually six care staff on duty in the mornings and four or five in the afternoons. They are supported by catering and domestic staff. At night (7pm 7am) there are two waking staff members. The manager is on call if needed at night. Surveys returned from nine staff members said there are always or usually enough staff members on duty to meet the needs of the people who live in the home and they feel well supported by the manager. Most of the people who spoke with the Expert by Experience were of the opinion that there are sufficient numbers of staff on duty. However staff do not have time to spend talking with people and those people who spend a lot of time in their bedrooms said that staff only come to check on them to carry out specific tasks. People said that the call-bell response time was usually within five to ten minutes with little difference between day and night times. However we saw and heard that, during our visits, the call bell was answered more quickly than this and one person, in a survey, said that the staff answer all call bells promptly. Without exception all the people who live in the home speak very highly of the manager and her staff. They told the Expert by Experience that the staff are very Care Homes for Older People Page 22 of 30 Evidence: good; they try to make us as happy as they can possibly do; they cheer us up and are joyful; the girls are really good and helpful and the staff are wonderful. Information in surveys from staff showed that Vicarage House is a good place to work. In particular they praised the support they receive, from both peers and management, to do their job. The personnel files of two care staff, who have been recruited since the last inspection in April 2009, were examined. These were very well organised and information was easy to find. They showed that all the required checks and references were carried out before they started work in the home. However there were no records of the interviews that took place prior to new staff being appointed; there were no health declarations indicating that the new staff are fit to work in a care home; and there were no records of interviews that were carried out in relation to any criminal offences that care staff may have. The manager confirmed that the home has a nationally recognised induction programme for new staff, who have no prior experience in care, based on the standards expected by Skills for Care, the organisation responsible for setting the training standards for care staff. There is a shorter induction programme for newly recruited staff who have previous experience in providing care. Completed induction programmes were seen in the two personnel files inspected. Information contained in surveys from staff confirmed that the induction training was comprehensive and covered everything they needed to know to do their job. The manager said that staff are now receiving training from an independent trainer and this includes courses in moving and handling, health and safety, first aid, infection control, diet and nutrition, safeguarding vulnerable adults, administration of medication as well as training related to caring for older people, such as pressure area/skin care, diabetes and palliative care. Information in the AQAA said that ten of the twenty members of staff have obtained qualifications in caring for older people, namely National Vocational Qualifications (NVQs) at level 2 or above. Discussions with four staff members and the manager confirmed that all staff are expected to complete NVQs in due course. Each staff member has an individual training and development assessment and profile to show what training they have done, or are expected to do, to ensure they are trained and competent to do their jobs. The manager and the Responsible Individual for the company that owns the home have also attended training about the Mental Capacity Act and deprivation of liberty safeguards so are up to date on recent changes in social care legislation. Surveys from nine staff members confirmed that they have good training opportunities and consider that they have enough training to do their jobs well. Care Homes for Older People Page 23 of 30 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. People who live in the home benefit from the open and positive approach of the manager who runs the home in the best interests of the people who live there. The health, safety and welfare of the people living in the home are promoted and protected. Evidence: The manager has worked in the home since September 2007 and was appointed to the managers role in June 2008. She confirmed that she will be applying to register with the Care Quality Commission as soon as possible and has already started the process. The people living in the home and their relatives were very complimentary about the manager. Comments included: the manager is highly commendable, if they paid her double it wouldnt be enough; I get on with the manager fine; and the manager is very approachable and caring. Information in surveys from staff showed that they feel very well supported by the manager and her deputy and one person said they are always willing to listen to any new ideas which in turn benefits the running of the home. Other comments about the running of the home included: Care Homes for Older People Page 24 of 30 Evidence: They do everything for me - they are A1 and a visitor told the Expert by Experience that his friend is much more content at Vicarage House than he has been at other places hes lived. The Responsible Individual for the company that owns the home visits weekly to meet with the people living in the home, any relatives who may be visiting, and the staff. Formal meetings are held regularly for both people living in the home and staff so that people have an opportunity to comment upon the quality of the services provided and be given information about the running of the home. Documentation and information in surveys from staff show that the care staff have regular one-to-one meetings with their line manager that also includes direct observation of them providing care. These meetings and observations are designed to ensure that care is provided safely and in accordance with peoples wishes, improve the care practice of the staff and consider any training or career development needs. Discussion with the manager confirmed that the financial affairs of the people who live in the home are usually managed by themselves, their families or representatives. However the Responsible Individual administers the money of one person. The home does look after spending money on behalf of some people who live in the home. The financial records for three people were checked and found to be correct. The fire safety records showed that fire safety equipment is being tested and checked regularly to make sure the fire alarm system works properly and other equipment is positioned correctly and has not been tampered with. A local contractor services the fire alarm system, fire extinguishers and emergency lighting system at least once a year. Discussion with the manager confirmed that fire drills are held regularly, newly appointed staff receive training in fire safety procedures on the first day of employment and an external trainer visits twice a year to train staff. Whilst the names of staff attending fire safety training are documented there is no system to provide an overall view for the manager of which staff have completed this training. There is documentation in the home to show that the gas system and appliances were checked and serviced in February 2010. There is an electrical wiring certificate dated 4th February 2010 showing the outcome of the inspection to be unsatisfactory but the manager confirmed that the remedial work will be completed as soon as possible. All portable electrical appliances were checked for safety in February 2010. Servicing records show that the stair lift is due for a service and the manager confirmed this will be arranged. The home has two mobile hoists and these were serviced in November 2009. The manager confirmed that all the windows above the ground floor are restricted so that people cannot fall out of them and the windows we inspected were restricted. All the radiators are covered so that people will not be burned. The Care Homes for Older People Page 25 of 30 Evidence: manager confirmed that the hot water is not thermostatically controlled to prevent the risk of scalding. However we took the temperature of the hot water coming out of the taps in one bathroom and the water temperature was at a safe level (42 degrees centigrade). Also there are instructions for staff in each bathroom to follow to make sure that the hot water is at a safe temperature in the baths, bath thermometers are available to check this and the temperature of the water is documented. Discussion with a staff member assisting people to have baths confirmed that she is fully knowledgeable about the procedure to follow, always checks the temperature and knows what temperature is safe for people. The Public Protection Service of the Local Authority carried out a food safety inspection recently and made a requirement that the staff whose key responsibility is food handling need to complete a food hygiene training course. The manager and one of the staff concerned said this is in the process of being arranged. Inspection of documentation kept by catering staff show that the temperatures of refrigerators, freezers and hot food are documented. This is to make sure that equipment is operating at the correct temperatures and food is properly cooked. The home has a quality assurance system in place based on consultation with the people who live in the home and the results of this survey are made available to people who live in the home and their relatives/representatives. This system has been extended to include an annual internal audit of the facilities and services in the home to ensure that the aims, objectives and statement of purpose of the home are being met. Care Homes for Older People Page 26 of 30 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 27 of 30 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 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 9 The medication procedure should include information about the process staff should follow for people who hold and administer their own medication. Records should be kept of meals provided to people who live in the home. These should contain enough detail to determine whether the diet is satisfactory, in relation to nutrition or any other reason, and to make sure that people receive varied meals in relation to any special diets. The menus and the quality of food provided should be reviewed to ensure that people receive meals that are varied, appealing, wholesome and nutritious and are suited to peoples individual requirements or requests. All staff should attend the training provided by the Local Authority on how to keep vulnerable people safe from abuse or neglect. This is to ensure that staff are aware of the local procedures to be followed should an incident of abuse or neglect be suspected or alleged. Records should be kept of interviews when recruiting staff to work in the home, including any interviews in relation to criminal records. Application forms should contain a health Page 28 of 30 2 15 3 15 4 18 5 29 Care Homes for Older People 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 declaration for prospective new staff so complete to confirm they are fit to work in a care home. 6 31 The manager should apply to be registered with the Care Quality Commission to ensure that she is qualified, competent and experienced to run the home. Design solutions, such as thermostatically controlled valves, should be fitted to all hot water outlets accessible by the people who live in the home. This is to maintain the hot water at a safe temperature to ensure that people will not be scalded. A system should be put into place to provide an overall view of which staff have completed training in fire safety awareness. This is to make sure that no staff are inadvertently missed out and that all staff receive regular updates. 7 38 8 38 Care Homes for Older People Page 29 of 30 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 30 of 30 - 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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