Care Home: Victoria House

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What the care home does well The management team and the staff make sure that a high standard of care is given to all the people living at the home, with individual needs, choices and preferences being taken into account and dignity and independence being promoted. The people living at Victoria House made a lot of very positive comments about the staff including, "Staff are very caring and attentive to my needs." A friendly and well-behaved dog belonging to the manager spends time at the home, providing comfort and interest to those living there. The atmosphere is warm and friendly, helping people to feel relaxed and comfortable. The home is very well managed, with good systems in place. Excellent feedback was received from people living at the home and also from relatives. One relative wrote; "Victoria House is a small well run home with the most caring staff one could wish for. My ***** is extremely happy and contented there." People living at the home can be confident that their needs will be met and that they will be kept safe. Any risks are handled well, with good staff training and safety checks helping to make sure that people are kept safe. There are good systems in place to monitor whether the service is meeting people`s needs and expectations. The management team are always looking at ways to make improvements. The owner has made sure that all people living at the home have equal access within the building, by providing a stair lift and adaptations in the bathrooms. What has improved since the last inspection? The manager and the deputy manager have both gained qualifications, which will help them to maintain their high standards in managing this home. The people living there benefit, as the staff are very good and all aspects of the home are well organised. The owner of Victoria House continues to make improvements to the building, resulting in a well maintained and comfortable home. The outside paintwork has been redecorated and is looking very smart. A new call bell system has been fitted making it easier for anyone living at the home to call for staff assistance. The first floor bathroom has been refurbished, making it more suitable for people with mobility problems. Some bedrooms have also been refurbished. New emergency lighting has been installed and some new fire doors fitted. New equipment has been purchased for the laundry, kitchen and office area, all helping towards the smooth running of the home. What the care home could do better: Some people living at the home, use bed rails to prevent them falling out of bed. Extra care has to be taken when using this equipment and the regular checking of the rails and always having covers on the rails would provide extra safeguards. The medication arrangements at Victoria House are very good. However when handwritten records have to be made these should be checked by two staff. This would help to ensure that errors are not made.The written policy regarding abuse should be amended to include the role of Social Services. This would mean that all staff know what to do, should a concern be raised. If more staff gained qualifications and regular staff supervision sessions took place, then this would improve the already good staffing arrangements at the home. People living at the home would benefit from an even more capable staff team. Proper checks must always be made before care staff start work. Not doing this could pose risks to the people living at the home. CARE HOMES FOR OLDER PEOPLE Victoria House 2 Victoria Road Poulton Le Fylde Lancashire FY6 7JA Lead Inspector Lesley Plant Unannounced Inspection 12th September 2008 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria House Address 2 Victoria Road Poulton Le Fylde Lancashire FY6 7JA 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) 01253 892400 Mrs June Patricia Wilkinson Mrs Pauline Elliott Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies 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 The maximum number of service users who can be accommodated is: 15 Date of last inspection 19th September 2006 Brief Description of the Service: Victoria House provides residential care and is registered to accommodate up to 15 older people of either sex. The home is situated in a residential area of Poulton-le-Fylde and is close to shops and local amenities. Victoria House is well served by public transport, being on a bus route and close to the railway station. Communal accommodation is situated on the ground floor and the bedrooms are situated on the ground and first floors. A stair lift is in place to assist those residents who cannot manage stairs. At the time of this visit the information given to the Commission for Social Care Inspection showed that the fees for care at the home are £372.00 per week, with added expenses for hairdressing and chiropody. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The visit to the home was unannounced and looked at all of the key national minimum standards, plus the standard relating to staff supervision. At the time of the visit there were 12 people resident at the home. The inspector spoke to the owner of the home, the manager, the deputy manager, the cook, several residents and two relatives who were visiting. Information was also gained from the Annual Quality Assurance Assessment completed by the owner. The Annual Quality Assurance Assessment is a selfassessment that focuses on how well outcomes are being met for people using the service. It also provided some numerical information. CSCI survey forms inviting feedback about Victoria House were received from four members of staff and eight people living at the home, with some relatives also making comments on these surveys. Records were viewed and a tour of the building took place. Time was also spent observing staff and the people living at the home, as they went about the day’s activities. Since the last key inspection in September 2006, a ‘random’ inspection and a service review have taken place. (Random inspections are conducted to look into particular areas of service provision and do not look at all the key national minimum standards.) Reports regarding these are held at the CSCI office and would be made available to if requested. What the service does well: The management team and the staff make sure that a high standard of care is given to all the people living at the home, with individual needs, choices and preferences being taken into account and dignity and independence being promoted. The people living at Victoria House made a lot of very positive comments about the staff including, “Staff are very caring and attentive to my needs.” A friendly and well-behaved dog belonging to the manager spends time at the home, providing comfort and interest to those living there. The atmosphere is warm and friendly, helping people to feel relaxed and comfortable. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 6 The home is very well managed, with good systems in place. Excellent feedback was received from people living at the home and also from relatives. One relative wrote; “Victoria House is a small well run home with the most caring staff one could wish for. My ***** is extremely happy and contented there.” People living at the home can be confident that their needs will be met and that they will be kept safe. Any risks are handled well, with good staff training and safety checks helping to make sure that people are kept safe. There are good systems in place to monitor whether the service is meeting people’s needs and expectations. The management team are always looking at ways to make improvements. The owner has made sure that all people living at the home have equal access within the building, by providing a stair lift and adaptations in the bathrooms. What has improved since the last inspection? What they could do better: Some people living at the home, use bed rails to prevent them falling out of bed. Extra care has to be taken when using this equipment and the regular checking of the rails and always having covers on the rails would provide extra safeguards. The medication arrangements at Victoria House are very good. However when handwritten records have to be made these should be checked by two staff. This would help to ensure that errors are not made. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 7 The written policy regarding abuse should be amended to include the role of Social Services. This would mean that all staff know what to do, should a concern be raised. If more staff gained qualifications and regular staff supervision sessions took place, then this would improve the already good staffing arrangements at the home. People living at the home would benefit from an even more capable staff team. Proper checks must always be made before care staff start work. Not doing this could pose risks to the people living at the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 does not apply to this home.) Quality in this outcome area is good. Good assessments take place, prior to anyone moving into the home. This helps to ensure that the persons’ needs could be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deputy manager explained that either himself or the manager of the home carry out the assessment of new people. Both are qualified and have experience in this area. Records showed that good pre admission information is gathered and that relatives are involved in this process. Information includes details of health and social care needs and highlights any areas of risk. This pre admission Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 10 assessment means that individuals are not admitted to the home if their needs cannot be met. Files also contained individual signed contracts. The home has introduced a two-week trial period, when further information can be gathered and the individual involved can make sure that they would be happy at the home. Information from this assessment process is then used to inform the care plan. For one person the pre admission information stated that the person smoked. The care planning information contained an appropriate risk assessment and a risk management plan, explaining how staff would support this person regarding smoking. Information within the new brochure for the home confirms the two-week trial period and explains that day care and short stays are also provided at the home. An individual who had been recently admitted to the home had previously attended for day care and had then come for a short stay, giving opportunity for her and her family to find out more about the service provided and to then make a decision regarding a permanent move to the home. There is a policy that any room, which becomes vacant, is firstly offered to existing residents, should they want to move rooms. A relative spoken to explained that the family had chosen Victoria House as they had heard of its’ good reputation and were very happy with the care provided. Victoria House does not provide intermediate care or short-term intensive rehabilitation. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. Personal and health care needs are met and people are treated with dignity and respect, promoting a feeling of wellbeing and confidence that any health problem would be dealt with. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a written plan of care and three of these were viewed. Staff keep a daily record for each person and these records along with the care plan are reviewed at least every month, with changes made to the care plan if needed. A relative had commented on a CSCI survey; “My mother has been in Victoria House for over three years and has always been well looked after. As her condition has deteriorated they have adjusted the care she needs.” On the day of this inspection two visitors were spoken with and both expressed satisfaction with the care provided to their relative. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 12 Each person has a risk assessment regarding mobility, detailing any support needed. Other risk assessments seen addressed smoking, wandering, falling, poor personal hygiene, alcohol, using bedrails and for one person, becoming withdrawn. It is good that such emotional needs are being addressed and for this person the plan stated that one to one time with staff must be provided. Each risk assessment concludes with a plan and guidance for staff as to how to minimise the risk and this is regularly reviewed. Although risk assessments are in place regarding the use of bed rails to prevent falling from bed and signed agreements from the individual or their relative are in place, these could be strengthened by including the need to regularly check the equipment and ensure that the rails are covered. Responses in the CSCI surveys completed by people living at the home confirmed that medical support is provided. Comments included; “The Doctors’ is only over the road and the home has a good relationship with them” and “I am not on any medication but the staff arrange doctors, clinic and hospital appointments when required.” Health care is recorded in the daily records kept by staff and as this is a small home, staff get to know people well and can spot any changes in health or wellbeing. Concerns regarding one person had been referred to the community mental health nurse, showing that specialist advice is sought when needed. Should anyone have an accident, a record is kept and changes to the care plan made if needed. A chiropodist regularly visits the home, providing foot care to those living there. A record is kept of each person’s weight, with any significant changes being responded to. The inspector advised that this should be kept as an individual record, with not everyone’s weight records kept on one page as at present. Individual records should always be kept, as combining records does not follow the good practice principles of data protection. The district nurse has been involved regarding the care of an individual with diabetes. Staff have been shown how to test blood sugar levels, which is done twice each day and records are kept. Staff are aware of what to do should a high or low blood sugar level occur. A risk assessment is in place. The privacy and dignity of those living at Victoria House is supported and promoted. The importance of this is addressed within the induction programme for new staff. It was seen during the inspection that staff would knock on the bedroom door and seek permission before entering. During lunch a member of staff was seen providing support in a quiet and sensitive way, so as not to cause embarrassment to the individual concerned. Each bedroom has a washbasin, meaning that individuals can wash in the privacy of their room. There are three double bedrooms at the home, however these are used by just one person, with the owner explaining that unless a couple come into the Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 13 home or two people wish to share a room, the double rooms would continue to be used for just one person. Individual preferences regarding bathing and dressing are recorded and followed by staff. Two hairdressers regularly visit the home, providing a service to those living there. The deputy manager, who has a particular responsibility for the medication arrangements, met with the inspector to look at this area of health care. Medication is safely stored in a cupboard, which is kept locked. Only senior staff, who have undertaken training, administer medication. Medication administration records for two people living at the home were looked at and these had been completed correctly. Occasionally staff have to make a handwritten entry onto the medication record and it would help to reduce the chance of any error if this was checked and signed by two people. Medication records include a photo of each person. A separate file contains the medication information leaflets for each person’s medication. These give information about how the medication should be given and details of possible side affects. This is a very good source of information and is available for anyone to refer to. The dispensing pharmacist visits the home to check the arrangements and to provide advice if needed. The pharmacist provides most of the medication in a sealed cassette container ready for staff to administer. Medication such as liquids and creams are supplied in the original container. Staff sign this when it is first used, which is very good practice and allows for checks to be made and helps to avoid any medication being used after its’ use by date. Individuals may administer their own medication if they are able. At the time of this visit one person was doing this, with support from staff. It is good that this lady is being supported to maintain her independence in this way and that this part of health care is dealt with individually and that the home does not take a ‘blanket’ approach and automatically take responsibility for all medication. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15. Quality in this outcome area is good. Community links and activities are supported, providing interest and promoting relationships. People enjoy the meals that are provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this visit a visitor confirmed that her relative was happy with the activities provided. Individuals spoken with also expressed their satisfaction, which was endorsed by responses on the CSCI surveys completed by people living at the home. The weekly activity plan was seen, showing that each day a planned activity was provided. On the day of this visit an exercise to music session took place, lead by an external professional. It was seen that nearly all those living at the home joined in with this exercise session. A singer comes into the home to perform for those living there. Quizzes and bingo take place, as well as trips out. One person living at the home explained that she enjoyed the trips to see Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 15 shows at the theatre. Annual events include a summer garden party and a Christmas party. One person is supported to attend her local community centre each week, enabling her to maintain her links with her old friends. Local church ministers visit, giving opportunity for religious observance. A newspaper is delivered each day and people can also arrange for their own paper if they wish. Staff carry out little beauty treatments with the ladies, such as painting their nails, this encourages pride in appearance, a feeling of self worth and allows a good opportunity for a one to one chat. Visitors are made welcome as seen during this inspection, with a drink being offered and staff giving them a warm welcome. A member of staff has a friendly and well-behaved dog that stays at the home, providing comfort and interest to those living there. People are supported to make decisions about their day-to-day lives, such as when to go to bed, when to get up and how to spend their time. An individual recently admitted to the home and her relatives were involved in the redecoration of her bedroom. This shows that peoples’ views and opinions are valued and autonomy is encouraged. Individuals are supported to manage their financial affairs for as long as they are able. For some people a family member takes on this responsibility. People living at Victoria House are happy with the meals provided. Comments from CSCI surveys included; “The food is very good and plentiful” and “the meals are very good and sufficient.” The cook makes the lunch and tea time meals, with care staff preparing breakfast and snacks at other times. The main meal is served at teatime. A menu board in the dining room lets people know the meals for that day with people being able to request an alternative if they wish. This happened on the day of this visit, with one person requesting egg on toast instead of the listed lunchtime meal. The cook explained that he is responsible for ordering the food and that there are no major restrictions on how much is ordered or spent. The cook also stated that he knows peoples food preferences and is aware of the specific needs of one person who has diabetes. A four weekly menu is in place and the cook explained that he and the staff talk to people about any changes to this menu and include any popular suggestions. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. People living at the home are able to raise any concerns, with policies, procedures and staff training helping to ensure that any such concerns are dealt with. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints policy is in place and this is made available to all those living at the home and their relatives. A copy of all policies is also kept in a main file for staff to access. Information is clearly provided for people living at Victoria House in the event of them, or their relatives wanting to make a complaint about the home or its staff. Responses in the CSCI surveys completed by people living at the home confirmed that people know who to speak to if unhappy and how to raise any concerns. One person commented; “Pauline (the manager) is always available to speak to if necessary.” The surveys completed by staff also showed that staff know what to do if anyone has concerns about the home. Information within the Annual Quality Assurance Assessment completed by the owner of the home states that staff aim to solve problems quickly and that all Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 17 complaints are taken seriously and investigated promptly. Previous inspections and contact with the home has shown that this is the case. The home has received one complaint during the last 12 months, which was dealt with according to written procedures. The home has policies and procedures in place regarding abuse and the protection of people living at Victoria House. Staff have easy access to these documents, which include guidance for staff should they be concerned about the work performance of another staff member. All staff undertake training regarding the protection of vulnerable people and issues regarding protection and vulnerability are addressed during the induction of new staff and also within NVQ (National Vocational Qualification) programmes. There are good arrangements in place for the safekeeping of personal monies, with separate account sheets being kept and the cash held being checked regularly. The procedures regarding protection and how to respond should any allegation be made were discussed with the owner and also with the manager of the home. Both were aware of what to do under such circumstances, as demonstrated when a concern had been raised last year and Social Services were informed. However the written policy should be amended to include the role of Social Services. This will mean that all staff have the correct written guidance to follow, should it be needed. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. Victoria House is comfortable, clean and well maintained, providing a pleasant and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Victoria House is close to local shops and amenities. A look around the home showed that the building appeared well maintained, homely and comfortable, with a good standard of furnishing and decoration. On the ground floor there are two lounges and a dining room, giving a variety of places to sit. Bedrooms are on the ground and first floors, with a stair lift in place to help people who have mobility problems. Each bedroom has a washbasin, meaning that people are able to wash in the comfort and privacy of their own room. There are two large bathrooms, one on each floor. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 19 People are able to personalise their bedroom by bringing their own personal items, such a pictures and ornaments. Outside is a small garden and seating areas at the back of the home, although as there are steps down to this area some people would need staff help to go into the back garden. There have been improvements made to the home since the last key inspection. The first floor bathroom has been refurbished and fitted with a large easy access shower and non-slip flooring. A new call bell system has been fitted making it easier for anyone living at the home to call for staff assistance. New emergency lighting has been installed and some new fire doors fitted. Some bedrooms have also been refurbished. The outside paintwork has been redecorated and is looking very smart. New equipment has been purchased for the laundry, kitchen and office area, all helping towards the smooth running of the home. The home appeared fresh and clean. At present there is no cleaner at the home, with care staff carrying out all domestic tasks. Staff must be working very hard to combine the cleaning work with their care duties. A cleaning rota was seen, showing when tasks should be done. Nightstaff do some cleaning and all the ironing of clothing. No washing is done after 8pm so as not to disturb people who may be sleeping. The eight people living at the home who completed CSCI surveys all responded ‘Always’ to the question, “Is the home fresh and clean?” A relative had added, “My mother frequently says how nice and clean everything is.” Containers of hand gel were seen in various parts of the home, including the toilets and dining room making it easy for staff and those living at the home to use the gel and reduce risks of infection. Staff training records show that most staff have completed infection control training meaning that they know how to reduce the risks of infection within the home. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. The staff team are well trained and experienced, meaning that the people living at the home are supported by competent staff. Not following agreed recruitment procedures could pose risks to people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are always at least three staff on duty each morning, with an additional member of staff on duty two mornings each week, which allows the manager to focus on her administrative tasks. On the day of this visit there were three staff on duty during the morning. In the afternoons and evening there are at least two staff on duty, with one person on duty all night and another sleeping in and available to help should an emergency arise. A cook is employed to make the main lunch and tea time meals and a part time gardener works at the home. The owner of the home is also present on at least two days each week. Responses from the CSCI surveys completed by those living at the home confirmed that staff are available when needed and the four members of staff Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 21 who completed surveys all responded that there are enough staff to meet the individual needs of the people in the home. Feedback, about the staff, from relatives and those living at the home was extremely positive and included the following comments. “Very caring staff.” “Victoria House is a small well run home with the most caring staff one could wish for. My mother is extremely happy and contented there” and “staff are very caring and attentive to my needs.” There have been few changes to the staff team, meaning that people living at the home are supported by staff who know them well. This was clear, when watching staff going about their duties and when listening to their communication with the people living at the home. From looking at training records, information within the Annual Quality Assurance Assessment and discussions with staff it is clear that qualification training for staff is promoted at Victoria house. This means that staff have their work practice assessed and will lead to the staff team gaining skills in care work. There are ten members of care staff, excluding the manager of the home. Four of these have gained a NVQ (National Vocational Qualification) award at level 2 and three staff are currently working towards this. The deputy manager has gained his NVQ level 4 award and is also now a qualified NVQ assessor. This means that he is now able to carry out assessments for the staff who are working towards gaining an NVQ. The owner and manager are keen to increase qualifications within the staff team. Up until recently over half of the care staff were qualified and the owner is keen to increase the number of staff with a NVQ qualification. With having an assessor on the team and three staff enrolled on the NVQ programme, this should be very soon. Equal opportunities are evident in the recruitment of staff of both sexes, of mixed ages and different ethnic backgrounds. The recruitment records for two recently appointed members of staff were viewed and discussed with the manager of the home. The records for one person included an application form; job description, two references and a Criminal Records Bureau (CRB) clearance plus a check against the Protection of Vulnerable Adults (POVA) list, a list of staff who it is deemed should not be working in care services. These references and checks help to ensure that only suitable people are employed and that people living at the home are protected. It was clear from looking at the records held that this good staff recruitment procedure is usually followed. However the records for the second recently appointed member of staff did not include a CRB clearance or a check against the POVA list. There was also only one reference available. The staff member had started work and was working on the day of this inspection visit. The manager explained that there had been delays in gaining the necessary checks and that the member of staff was being closely supervised. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 22 Shortly after this visit the inspector was informed that the POVA check had been received, however there are clear regulations regarding appointing care staff and these must be followed. Looking at training records, talking to staff and feedback from the surveys completed by staff all show that good staff training is arranged at Victoria House. There is a thorough induction for new staff with a record kept. A fire safety workbook is also completed. There is a good programme of training which includes moving and handling, health and safety, food handling, dementia, first aid, medication, challenging behaviour, protection of vulnerable adults, fire safety and infection control. These courses all help to give staff knowledge and skills for their work and help the people living at the home to receive a good standard of care. Training is very well organised, with records showing when each course has been done and the dates for courses planned for the coming year. Training courses take place almost every month. On the day of this visit a moving and handling course was taking place giving new staff opportunity to learn skills and experienced staff the chance to update their existing skills. The four staff who completed CSCI surveys all responded that their induction covered everything they needed to know and that they received relevant training, including training to help them meet the individual needs of people living at the home. To the question, what does the service do well? One person stated “Look after clients and make sure all staff attend courses to keep up with individual needs.” Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. Strong leadership and good systems for maintaining high standards mean that the people living at Victoria House receive a good standard of care. Policies, procedures, good practice and staff training promote the health and safety of those living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is very experienced, registered with the CSCI and, along with the deputy manager, has completed the Registered Managers Award and NVQ level 4 in Care. These are the recommended training courses for someone managing a care home. The owner, manager and deputy manager meet together regularly to discuss any issues and make plans for the future. Each of these Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 24 three has a different role but work closely together to manage the home very well. This management team appear to work well together and provide strong leadership in the home. During this visit information was easy to find, with very clear systems in place and good records being kept. This means that staff can readily find the information they need to help them in their caring role. There are good arrangements in place for people to give feedback about the home, for any views to be responded to and for continual improvements to be made. These aspects, along with good management are a real strength of the home. Surveys are regularly sent to people living at the home, relatives and staff. Some of the recently returned surveys were viewed and showed a general satisfaction with the care provided at the home. Regular staff meetings take place and the minutes of recent meetings were seen. These showed that issues are not only discussed but also dealt with. For any staff who do not like to speak out in this group setting, the owner makes herself available after each meeting so that staff can chat in private if they wish. A regular newsletter is distributed to everyone connected with the home, keeping people up to date and giving a sense of involvement. Victoria House has gained the Investors in People award and this has recently been reviewed and reaffirmed. This is a national quality standard which sets a level of good practice for improving an organisations performance, with effective management being a key factor. The atmosphere at the home is warm and informal with staff spending time talking to and listening to the people living there. There are also occasional meetings for the people living at the home, where suggestions such as menu changes are made, although the majority of people prefer to share their views and ideas on an individual basis as part of day-to-day life at the home. This individual approach also means that people with hearing difficulties are not excluded or disadvantaged. There are good arrangements in place for looking after personal money if this is needed. Small amounts of spending money can be held on behalf of people living at the home. Individual account sheets showing income, expenditure and the balance of money held, were seen. All money is securely kept in a safe and the accounts are regularly checked. Only the manager and deputy have access to the safe, providing extra safeguards. The manager and deputy manager work alongside the care staff at the home. This means that they are able to guide staff and show them how they want them to work. The four staff who completed CSCI surveys all responded that Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 25 the manager regularly meets with them to give support and discuss their work. This support is carried out informally as part of day to day working. The manager caries out formal staff appraisals and some of these records were seen. The form used is very good as it includes a section for the member of staff to consider and then rate their own work performance. This encourages staff to think about how they work, the things they are good at and the things they may need help or training with. The manager was trying to conduct these full appraisals every three months, but this has proved difficult and staff have found it repetitive. Appraisals will now be carried out each year. Staff supervision was discussed with the manager. Although staff feel that they are supported in their work, staff should have the opportunity to meet privately with the manager on a regular basis. At least six times each year is seen as good practice. This meeting does not have to be lengthy, but provides an opportunity to discuss work practice and training needs as well as any other practical issues related to working at the home. Records relating to health and safety were seen. These included records of checks such as fridge and freezer temperatures, which are kept by the cook. Records also show that equipment such as the stair lift and fire equipment are regularly serviced and that the electrical and gas supplies at the home are also checked. Fire drills take place. Risk assessments are in place regarding any potential risks to staff, such as from using cleaning materials. All these checks and practices, along with the training staff receive help to protect the people living at the home and the people working there. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 26 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Timescale for action Staff must not start work until all 30/09/08 the checks required by regulation have been made. This will help to ensure that only suitable staff are employed. Requirement 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 3 4 5 Refer to Standard OP7 Good Practice Recommendations Risk management plans for bed rails should include checking the equipment and the need to use protective padding/covers. This will help to keep people safe. Handwritten medication records should be checked and signed by two staff. This will help to reduce the chance of errors. The abuse policy should clearly outline the role of Social Services as the lead agency. All staff will then know what to do, should an allegation be made. At least 50 of care staff should be qualified at NVQ level 2 or above. This will mean that more staff can increase their skills and so provide a good service. Care staff should receive formal, recorded supervision at DS0000009714.V367150.R02.S.doc Version 5.2 Page 28 OP9 OP18 OP28 OP36 Victoria House least six times a year. This will provide opportunity for any issues to be raised and work performance to be discussed. Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Victoria House DS0000009714.V367150.R02.S.doc Version 5.2 Page 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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