Care Home: Victoria House

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What the care home does well Findings from this inspection indicate that the service is run in the best interests of the people who use the service and that they are at the forefront of any planning and decisions made. The atmosphere is relaxed and comfortable, and we observed positive interactions between the people who use the service and the staff. What has improved since the last inspection? This is the first inspection of the service under the new organisation name. However, at the previous inspection there had been four areas where the service had to improve. The service has taken action on all of these areas, which represents a positive response to the findings of the last inspection and good developments to the service. In particular, good improvements had been made to the medication training and record-keeping. What the care home could do better: Areas where the home could be doing better are highlighted in the report and were discussed with the manager and regional manager during the inspection. This includes improvements to the care planning system, environment and the supervision and appraisal of staff. Key inspection report Care homes for older people Name: Address: Victoria House 2-4 Ennerdale Road Richmond Surrey TW9 3PG     The quality rating for this care home is:   three star excellent 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: Louise Phillips     Date: 2 6 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Victoria House 2-4 Ennerdale Road Richmond Surrey TW9 3PG 02089400400 02083329867 t.mclaughlin@abbeyfield.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Abbeyfield Society Name of registered manager (if applicable) Mr Emmanuel Kwadzo Torsoo Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 30 The registered person may provide the following categoruies of service, 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 Date of last inspection Brief description of the care home Victoria House is operated by the Abbeyfield Society, and provides care and support for up to thirty older people. The home is situated a short walk from Kew Gardens and the London Underground station, with local shops and amenities available in Kew Village. Care Homes for Older People Page 4 of 29 Over 65 30 0 Brief description of the care home There is limited parking to the front of the property, and the surrounding streets are part of a controlled parking zone. At the time of the inspection the manager informed us that the fees for the service range from 680 to 730 pounds per week. Care Homes for Older People Page 5 of 29 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: three star excellent 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 took place over one day and included a visit to the service by a Regulation Inspector. During the inspection we looked at the environment, and at records and relevant documentation held at the service. Whilst we were at the home we spoke to staff, some people who use the service, and we observed what was going on. We also looked at the AQAA for the service, which is the Annual Quality Assurance Assessment that the manager completed about the service, which tells us about developments to the service, and areas of improvement that have been identified and planned for. Since the last inspection of the home there has been a change of provider name, where the Registered Provider name is now the Abbeyfield Society. Care Homes for Older People Page 6 of 29 Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 8 of 29 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 9 of 29 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. The assessment process is thorough to ensure that the service is the right place for new people to move to. Evidence: Prior to people moving to Victoria House, they are appropriately assessed by a senior member of staff to ensure that the service is able to meet their needs. At the start of the assessment the service receives needs assessments and care plans from the local authority and from this the home carries out its own pre-admission assessment. This information is then used to form the basis of the care plan for the person. The assessment covers all activities of daily living of that the person is involved in, including personal cleansing and dressing, their sleep pattern and their independence in mobilising. As part of the assessment process potential residents are invited to visit the home to Care Homes for Older People Page 10 of 29 Evidence: meet staff and people who live there and look at the service provided. People move in for an initial trial period of six weeks. Prior to the end of the six weeks a review meeting is held between the person, their relative, social worker and manager of the home to review their stay and for the person to decide if they want to stay. The home does not provide intermediate care. Care Homes for Older People Page 11 of 29 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. The needs of people who use the service are met, though improvements need to be made to the care planning information to ensure that they provide sufficient information. Evidence: People who use the service said that the service is the right place for them, and they feel that they have everything they need to go about their daily lives. One person commented that ..its lovely here... During the inspection we looked at the care files of a three people who use the service. The current care plan is formatted through identifying where the person needs support, the action to support them with this and the goals and timescale for this. The care plans cover different areas of need, such as personal care, mobilising, social needs, safety needs and involvement of professionals in their care. Care Homes for Older People Page 12 of 29 Evidence: The care plan actions are detailed, though the care plans are let down by the information given in the actions to be taken to meet the goals. This is because for the majority of care plans, under the actions heading, it simply states all staff to assist and monitor on-going which does not detail any actual actions or goals. The care plans are also reviewed monthly, though apart from the date of this, no information is given as to process of this or the evaluation of the care plans. Similarly, the care care plans have not always been updated to reflect changes in needs of the person. An example of this is where an incident report in one person file states that they had a fall, though the care plan had not been updated regarding this. We were informed in the AQAA, and during the inspection that the current care plan format is under review, with a new care planning system due to be introduced at the service. The format for this was seen and is much more focused around what the person can do for them self and what they need help with. This will allow for better details about the goals of the person, and the actions needed for them to achieve these. The care files each contain a risk screening tool to minimise risks to people who use the service. These were seen to include risk management plans around areas such as manual handling, mobility for falls, bedroom environment and the person going out. These are detailed and are specific to peoples individual needs around areas such as sight impairment, diabetes and moving and handling issues. During the inspection the staff were observed being polite and courteous to the people who use the service. Staff spoke fondly about the people who use the service and have a good understanding of their needs. We observed genuinely caring and positive interactions between the staff and people who use the service. However, we observed that during the handover period, between the morning and afternoon shift, where important, confidential information is passed on about the people who use the service, the office door was left open where residents were walking around. This must be kept shut when passing on confidential information, to maintain the privacy and dignity of the people who use the service. The medication held at the service was checked. These were seen to be generally well managed, with the medication held securely, and appropriate records maintained. We identified no errors apart from a box of paracetamol that was being used as a homely remedy, which had had a part of a label removed from the packaging, where the label remaining had the name of a person who uses the service. Medication prescribed for people who use the service must not be given to any other resident, and a Care Homes for Older People Page 13 of 29 Evidence: requirement has been made for the service to address this. The care files hold records of all health care appointments that people attend, and the care plans detail the level of support that people need regarding their going to see their GP, or the involvement of the district nurse in their care. Annual reviews of peoples care takes place with the involvement of the relevant health and social care professionals and the person who uses the service. Care Homes for Older People Page 14 of 29 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. People who use the service are supported to pursue individual interests and activities both inside and outside the home. There is a relaxed, warm atmosphere at the home which is enhanced by the positive relationships between the staff and people who use the service. Evidence: The people we spoke to said that they like living at the service and that they have ...made a lot of new friends... The photographs on display in the hallways show recent visits to Kew Gardens, a trip to Buckingham Palace and a river boat trip. There is a full-time activity co-ordinator who is supported by a full-time volunteer, who plan and provide a number of activites at Victoria House. The activities that take place include shopping trips, coffee mornings, visiting entertainers, quizzes, theatre trips and board games. Duirng the inspection we saw people who use the service getting involved in different activities arranged by the co-ordinators. Care Homes for Older People Page 15 of 29 Evidence: Meals at the home are provided through an external catering contractor, where they used to be provided by the service. The manager explained that this was in response to feedback from people who use the service being unhappy about the meals provided at the service. The manager said that a lot of consultation takes place between the himself, the catering contractor and the people who use the service to try and ensure the food is satisfactory. Records were seen to demonstrate that people who use the service are regulalry consulted about the meals provided. A recent residents meeting also demonstrates that a dietician has also visited the service to be involved in this process. As part of the inspection we had a look at the foods held in the kitchen. This was being held appropriately, apart from the labelling of foods that had been opened, as this was unclear. This is because some opened food packets, and jars where food had been decanted into, had dates on them, though it was unclear if this was the dated of when opended, or when it was to be used by. Some opened food containers in the fridge and dry stores had no labels on them. A requirement has been made for the service to address this. to ensure that nutritious food is provided at the service at all times. Care Homes for Older People Page 16 of 29 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. There are systems in place to reduce risks to people who use the service. Evidence: The service has a complaints procedure that is provided in the Service Users Guide and Statement of Purpose. The procedure is also displayed around the home. There is a file held in the managers office specifically for the logging of complaints, along with records of actions taken and any correspondence relating to these. This contained details of one concern, and records of how this was managed my the service. There have been no safeguarding issues reported about the service. The training records indicate that most staff have received training in safeguarding vulnerable adults, and that this is planned for those who have not yet received the training. A small number of staff have also had training in the Mental Capacity Act, and Deprivation of Liberties Safeguards. There are also policies in place relating to these areas. However, in relation to Deprivation of Liberties, the care file of one person who uses the service a member of staff (who has undergone the training) had recorded that the Care Homes for Older People Page 17 of 29 Evidence: resident ..would not be able to have the ability to make informed choices or decisions.., where no Mental Capacity Assessment had taken place. This was highlighted to the manager during the inspection for them to address. Care Homes for Older People Page 18 of 29 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 environment is welcoming, homely and relaxed for the people who live there. The staff help create a calm atmosphere throughout the home. The decor and furnishings are good in most areas, though some improvements are needed to make the home more comfortable for the people who live there. Evidence: Victoria House is situated a short walk from Kew Gardens and the London Underground station. Local shops and services are available at Kew Village, also nearby. The home has several lounges, which provide opportunities for socialising or small group activities. There are also several dining areas, which enables people to eat in small groups. There is a well-maintained garden for the use of residents. Residents bedrooms vary in size and layout. The bedrooms seen were personalised and individually decorated. Residents are able to bring personal items with them on admission and are to install a private telephone line should they wish. The manager said that some people have also purchased there own flat screen television, where the home has installed a digital aerial to support the use of these. Care Homes for Older People Page 19 of 29 Evidence: There is a lift to all floors. There are a number of toilet and bathroom facilities situated around the service. These were seen to be in need of looking more homely. The baths in some bathrooms are very low, and the bathrooms too small to have a hoist to support people with bathing. We asked one resident how they use the bath in the first floor bathroom, where they informed us that they use the assisted bath, which is further along the hallway. There is a hairdressing room which was seen to be in need of redecoration, as the wallpaper was coming away from the wall. A trip hazard was also identified where the inspector tripped when coming out of a dining area, an this was reported to the deputy manager at the time. All areas of the home were clean and hygienic at the time of inspection. Care Homes for Older People Page 20 of 29 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. The service carries out appropriate recruitment procedures to minimise risks to residents. Staff receive training to enhance their skills and knowledge for working with residents. Evidence: Victoria House has a consistent staff team, some whom have worked at the home for a number of years, and who have a good understanding of the needs of the people who use the service. The manager informed us that the service is currently fully staffed. The staff said that they feel there is enough staff to meet the needs of the people who use the service. The home holds recruitment information on each member of staff. We looked at seven staff files, which were found to contain relevant information such as proof of identification, correspondence relating to offer of job, Criminal Records Bureau check, two references and record of the interview of staff. Some files do not contain a photo of the staff member. We saw evidence to confirm that new staff receive an induction to working at the home, and also that they are reviewed for a period of probation. The induction covers areas such as the service policies, health and safety, moving and handling and Care Homes for Older People Page 21 of 29 Evidence: introduction to the staff and residents. We looked at the training records for the staff. Records indicate that they receive mandatory training in areas such as fire safety and health and safety, as well as training in safeguarding adults, moving and handling and administering medication. The staff said that they get enough training to support them in their role, and that they have the right experience and knowledge to meet the residents needs. With one commenting that: its very good, I have learnt lots of things which help me to provide better care. The manager said that all staff are currently trained to National Vocational Qualification (NVQ) level two or three. Care Homes for Older People Page 22 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is competent and understands the responsibilities of their role. Findings from this inspection indicate that the service is run in the best interests of the people who use the service and that they are at the forefront of any planning and decisions made. Appropriate health and safety checks are carried out to minimise risks to the people who use the service. Evidence: At the time of inspection the manager was undergoing the process of becoming the Registered Manager for the service with the CQC. He has been the manager of the service for approximately seven months and has achieved the Registered Managers Award. He said that he has also worked for the organisation for a number of years, and was the deputy manager of an older persons service prior to gaining the managers position at Victoria House. Care Homes for Older People Page 23 of 29 Evidence: The manager says that he feels well supported by his line manager and the organisation, and he also spoke positively about the good teamwork at the service. Staff spoke enthusiastically about the home and their work, and how they feel well supported by the manager. They also say that they are supported to keep up to date in their work through good training opportunities. The manager and staff spoke with genuine fondness about the people who use the service, ensuring that they are at the forefront of decisions made, and that they are consulted about changes at the service. There is also a residents representative who meets with the manager on behalf of the other people who use the service to discuss any issues. Regular staff meetings take place and meetings with people who use the service occur approximately every three months. The regional manager carries out monthly visits in accordance with Regulation 26 of the Care Homes Regulations 2001. The service has a quality action plan that has been developed to further improve the service. The home holds a personal allowance for each person who uses the service that is funded by themselves, their family or through social services. This money is used for when a resident wants to go shopping or use the hairdresser, etc. Records are maintained of all transactions. The management of the money is overseen by the manager of the service, although the key for the safe is held in the staff office, where it is recommended that this is held by the manager or deputy manager, in the managers absence. There is a policy regarding the supervision of staff at the service, which says that oneto-one supervision support sessions should take place at least six times a year, which corresponds with the National Minimum Standards for Care Homes for Older People. with some people receiving this regularly, and some very infrequently. It is recommended that this is addressed, so that staff have a minimum of six supervisions sessions a year, at regular intervals, to ensure that they are appropriately supported in their work. The staff files also indicate that staff do not receive an annual appraisal of their work, and in some files their last appraisal happened in 2004 or 2005. It is recommended that all staff have an annual appraisal of their work. The service holds relevant certificates and records to indicate that appropriate checks Care Homes for Older People Page 24 of 29 Evidence: are carried out areas of health and safety, including the fire system, electrical installation and gas safety. All accidents and incidents are recorded, with good details about each incident. The service notifies the CQC appropriately about any incidents that occur. Care Homes for Older People Page 25 of 29 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must only be administered to the person that it is prescribed for. To ensure the safety of the people who use the service. 17/11/2009 2 10 12 The office door must be kept 17/11/2009 closed when discussing confidential information about people who use the service. To maintain confidentiality of information about people who use the service. 3 15 16 Food packets that have been 17/11/2009 opened, and those that have been decanted into other containers, must be appropriately labeled with the date of opening, and use by date, in accordance with manufacturers instructions. Care Homes for Older People Page 27 of 29 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 To ensure the food provided is nutritious for the people who use the service. 4 19 23 All parts of the service must be kept free of trip hazards. To ensure the safety of people who use the service. 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 17/11/2009 1 2 35 36 The key for the safe should be held by the manager on shift at all times. It is recommended that staff have a minimum of six supervisions sessions a year, at regular intervals, to ensure that they are appropriately supported in their work. All staff should receive an annual appraisal of their work. 3 36 Care Homes for Older People Page 28 of 29 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. 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