Care Home: Victoria House

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What the care home does well The home is near the town centre and shops and local amenities are within easy reach. A visitor commented that Victoria House had a good reputation in the village area. People are cared for in a clean and comfortable environment and the home is decorated to a high standard. All people spoken with made positive comments about the care they received; one said it was like being on holiday and another said that she enjoyed sitting in the garden in sunny weather. The staff group is well trained and knowledgeable about the people living at the home and how they prefer to be cared for. The manager has carried out many changes to policies and care plans since she took over the running of the home in April and there is a very stable staff group, enabling good knowledge of the needs of people. People are encouraged to make choices about their daily lifestyles and individual likes and dislikes are catered for. Victoria House DS0000073123.V377530.R01.S.doc Version 5.2 What has improved since the last inspection? This is a new service. The provider states in the AQAA that many improvements have already been made since the service was purchased. These include revised care plan documentation, purchasing rota stands and bed side rails, rigorous toileting routines, improving incontinence in people, improving security with a key-pad lock on the back door and a lock on one bedroom door at the request of the occupant, purchasing artistic tools, [paintbrushes etc.] for activities, new lockable drawers, regular checks on whether people are too warm or cold and an in-house trainer for moving and handling. What the care home could do better: Where service users are unable to sign their care plans and they have no other contacts, measures should be taken to use an independent advocate to assist with signatures. Regular advice should be obtained from a pharmacist regarding medicines policies within the home and medicines dispensed, to ensure that staff have up to date information to manage medication safely for people. An up to date copy of the Local Authority`s Adult Protection procedures should be kept in the home. The home`s procedures for adult protection should be updated in keeping with the Local Authority procedures. The use of hand towels in communal toilets should be reviewed, to prevent cross-infection. Key inspection report CARE HOMES FOR OLDER PEOPLE Victoria House 31 Station Road Alford Lincs LN13 9JB Lead Inspector Julie Western Key Unannounced Inspection 9th September 2009 09:00 DS0000073123.V377530.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Victoria House DS0000073123.V377530.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Victoria House DS0000073123.V377530.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria House Address 31 Station Road Alford Lincs LN13 9JB 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) 01507 463292 Mrs Reepaben Patel Mrs Reepaben Patel Care Home 16 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (16) of places Victoria House DS0000073123.V377530.R01.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 only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of people who can be accommodated is: 16 New service 2. Date of last inspection Brief Description of the Service: Victoria House is a two-storey, Victorian house situated on the main road through the small market town of Alford. It is within easy reach of the town centre and a bus service runs between the nearby larger towns of Mablethorpe, Skegness and Horncastle. The home changed ownership in March 2009 and the newly-registered provider is also the manager. The home has been modernised and adapted to provide accommodation for up to 16 older people, who may have a dementia. There are fourteen single rooms and one double room, nine of which have ensuite facilities. A stair lift gives access to the first floor. There is an enclosed garden to the rear of the building, a small car park to the side and on street parking is also available. Weekly fees range from £360 to £446 and information on these and the other facilities the home offers are available from the manager. Victoria House DS0000073123.V377530.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars - good. This means the people who use this service experience good quality outcomes. This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission (CQC). The visit lasted approximately two and a half hours and we took into account previous information held by us, the service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent out surveys to people before we visited the service. The main method used to carry out the inspection is called case tracking, which includes following the care of a sample of four people through their records and assessing their care. We spoke to two people who use the service, three visitors and one staff member. The manager and secretary/administrator were present throughout the visit and the general outcomes of the visit were discussed with them. What the service does well: The home is near the town centre and shops and local amenities are within easy reach. A visitor commented that Victoria House had a good reputation in the village area. People are cared for in a clean and comfortable environment and the home is decorated to a high standard. All people spoken with made positive comments about the care they received; one said it was like being on holiday and another said that she enjoyed sitting in the garden in sunny weather. The staff group is well trained and knowledgeable about the people living at the home and how they prefer to be cared for. The manager has carried out many changes to policies and care plans since she took over the running of the home in April and there is a very stable staff group, enabling good knowledge of the needs of people. People are encouraged to make choices about their daily lifestyles and individual likes and dislikes are catered for. Victoria House DS0000073123.V377530.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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. Victoria House DS0000073123.V377530.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 use this service have good information about the home in order to make an informed decision about whether the service is right for them. EVIDENCE: We saw the statement of purpose which was very comprehensive and contained terms and conditions and contracts. The service user guide we saw contained useful information for people. It was not in large print or in a format easy for older people to read. The manager said that she or a senior member of staff always visited prospective residents at home or in a care setting such as a hospital to Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 9 undertake a thorough assessment of all their care needs. Records we saw confirmed this. A resident we spoke with described how she had visited for the day with her relatives before she was sure she wanted to move in permanently. Another said ‘This is the best home out of the ones we saw’. A staff member described the admission process and the importance of making new residents and their families welcomed. The home does not provide intermediate care. Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in enough detail to ensure that the health care needs of people can be met. EVIDENCE: We saw written admission records that were clear and gave staff all the information needed. Care plans we saw contained information about the health and personal care needs of people. They were reviewed regularly and signed where possible by people or their relatives or advocates. They referred to new legislation on mental health issues and deprivation of liberties throughout. We looked at the medication records of the people whose care plans we tracked and found that they were clearly documented. We saw a medication policy that was clear and comprehensive. There was no record of a pharmacist visiting since 2007. The secretary/administrator said this was because the Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 11 pharmacist had been changed. A message was left with the new pharmacist to request an immediate visit. We saw that people received regular visits from district nurses and other professionals involved with their care. We saw staff carrying out their duties with kindness and sensitivity towards people, especially when attending to their personal needs. A resident we spoke with described how she had visited for the day with her relatives before she was sure she wanted to move in permanently. Another said ‘This is the best home out of the ones we saw’. A staff member described the admission process and the importance of making new residents and their families welcomed. Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are regular and are tailored to suit the individual needs of residents. People have a choice of meals from a balanced and varied menu. EVIDENCE: We saw a monthly diary of events, including entertainers, quizzes, various board and card games, karaoke and a monthly reminiscence session undertaken by a visiting activities worker. An outside organisation takes people out in a specially adapted bus for visits to local places of interest. There is also a local day centre which people could attend if they wished. On the day of the visit a church service was held at the home. The manager said that all religions can be catered for and visitors confirmed this. People we spoke with all said they had a choice of whether or not to take part. Some told us they preferred to sit in the quiet lounge instead or read books. Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 13 Visitors told us they were always made welcome and the atmosphere was always pleasant, with happy people. We saw the mid-day meal being served and eaten. People we spoke with all said they enjoyed the meals served; one said ‘It’s very good and there’s always plenty of it’. Another said she wanted her meal pureed and this was carried out. The menu for the day offered alternative choices of meals. The cook said that if people did not like any of these choices, she would make them an alternative within reason. The cook, who has worked in hotel catering for many years, has her basic food and hygiene certificate and is due to begin a course with ‘Learn Direct’ on nutrition. She was knowledgeable about the nutritional needs of service users and described cooking for three people on a pureed diet and one diabetic. Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 and their families are confident that their comments and concerns will be listened to by trained staff. EVIDENCE: People we spoke with said they did not wish to complain but knew how to make a complaint. The home did not have an up to date copy of the Local Authority adult protection procedures and the manager said she would download this from the Local Authority website. The home’s own procedures needed updating as there was conflicting information with the Local Authority procedures. The training programme showed that there was a rolling training course for staff on protection and safeguarding of adults. Staff members we spoke with knew what to do in the event of a serious concern and confirmed that they had received training in safeguarding people. Visitors we spoke with said that they were given information on how to make complaints. Since the last inspection there had been no complaints. Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 live in a comfortable and pleasant environment with both private and communal space that is suitable for their needs. EVIDENCE: The standard of decoration both externally and internally was high and residents said they were comfortable in their surroundings. The gardens were well maintained and offered a pleasant fully enclosed place for people to sit out in good weather. Staff described how any maintenance issues were addressed quickly by the husband of the proprietor, who also carried out all safety checks. Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 16 Recent improvements included redecoration of the main lounge including increased lighting, purchase of a new tumble drier and replanting of the gardens and front areas of the building. There were safety notices around the building to prevent the spread of infection and COSHH regulations were observed throughout. The most recent visit from the Environmental Health Officer found no issues of concern and the service had been awarded three stars – an excellent rating. The building smelled clean and fresh throughout, with the exception of one area near the entrance to the main lounge, where a resident frequently threw coffee dregs. The manager was aware of this and a carpet company was coming in two days to deep clean this area. Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers are in sufficient quantity for them to be able to care for people. Staff members are suitably trained, qualified and competent. EVIDENCE: The daily staff rota we saw showed that in addition to the manager, there were two care staff for 16 people. In addition there was a cook, two domestic staff and the proprietor’s husband who carried out any maintenance work and gardening. People and staff we spoke with all said they thought there were enough staff to complete their tasks in time. There were no vacancies at present and staff members we spoke with said that some staff had worked at the home for several years, giving stability to the team. We saw training records for staff and these showed that eight members of staff have achieved the National Vocational Qualification [a nationally recognised qualification] at Level 2 and two staff members had achieved Level 3, with one working towards it. One staff member has a Polish diploma in caring and another from the Philippines has a degree. We spoke with staff members who described how they had an interview, gave three references and underwent CRB/POVA [national criminal records] checks and had induction before starting work. Staff records we saw confirmed this. Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 18 Training records we saw showed that the training required by law has been undertaken, with moving and handling and infection control being the next training. We saw that staff members all receive regular supervision. There were also minutes of staff meetings. Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 well managed and the health, safety and welfare of people are promoted. EVIDENCE: The manager has been in post since March 2009, when she took over as proprietor of Victoria House. Her fitness to manage the service is evidenced by her business management qualifications and experience of care home management from working with her in-laws, who manage 3 care homes in London and Norfolk. She will be undertaking the Manager’s Award as soon as she is eligible, demonstrating her commitment to the position of manager. The Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 20 deputy manager has experience of having worked at the home for several years. Staff members spoken with said they the proprietor, her husband and the deputy manager were very approachable and accessible. There is a sound quality assurance procedure, with questionnaires for people, their relatives/visitors and staff. The results are collated and subsequently acted upon. Health and safety policies are well documented and demonstrate a clear commitment to ensuring the wellbeing of people. Policies and procedures had recently been reviewed. The secretary and the deputy manager manage monies for people and these are recorded and audited regularly by the manager. Maintenance records we saw showed that fire equipment tests and servicing of equipment are up to date. Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 2 4 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 22 Are there any outstanding requirements from the last inspection? New service STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15[1] Requirement Where service users are unable to sign their care plans and they have no other contacts, measures must be taken to use an independent advocate to assist with signatures. The use of hand towels in communal toilets must be reviewed, to prevent crossinfection. Timescale for action 18/12/09 2 OP26 13[3] 16[2][j] 18/12/09 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 2 Refer to Standard OP9 OP18 Good Practice Recommendations The manager should seek regular advice from a pharmacist regarding medicines policies within the home and medicines dispensed. An up to date copy of the Local Authority’s Adult Protection procedures should be kept in the home. The home’s procedures for adult protection should be updated in keeping with the Local Authority procedures. Victoria House DS0000073123.V377530.R01.S.doc Version 5.3 Page 23 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). 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