Care Home: Victoria House Care Home

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What the care home does well People`s needs are identified before going to the home and reflected in their support plans. People can make their own choices, take risks and have an active independent lifestyle. Meals are provided which is based onpeople`s needs and preferences. Medicine management promotes the people`s safety. People`s views are listened to people said they feel safe in the home. The home is clean and pleasant. people are supported by competent and qualified staff who are recruited appropriately. What has improved since the last inspection? People are now involved in the care planning process. Medications management is now effective in promoting the safety of people. Policies and procedure have now been updated effectively. What the care home could do better: Window restrictors and radiator guards could be installed to promote the safety of people at the home. The current care plans could benefit from being more person centered. Manager could ensure that all staff receive formal monthly supervision sessions. A staff training matrix could be used to show past and planned staff training provision. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Victoria House Care Home 59 Victoria Street Newark Nottinghamshire NG24 4UG The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Steve Keeling Date: 3 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Victoria House Care Home 59 Victoria Street Newark Nottinghamshire NG24 4UG 01636672290 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Dareen Marjorie Morgan care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: Date of last inspection A bit about the care home Victoria House is a large detached property close to Newark town centre. The home can accommodate up to three adults with a learning disability. There is a large garden to the rear and parking to the front of the property. The home is within walking distance of all local amenities. There are two bedrooms on the first floor and one on the ground floor. There is a shower room and toilet on the ground floor and a bathroom with toilet and a separate toilet on the first floor. The home is furnished and Care Homes for Adults (18-65 years) Page 4 of 29 decorated to a high standard. The fees are from 2,297.00 pounds to £3,353.00 pounds per calendar month. Care Homes for Adults (18-65 years) 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home We talked to people to get their views on the service provided at the home to ensure regulatory requirements and minimum standards of practice are met. We established the quality of care people receive by speaking to people, observation, reading records and asking staff about peoples needs. The manager, a member of staff, a visitor to the home were also spoken with. We looked at peoples bedrooms and the areas they use to make sure that the environment is homely and safe. We also used information about the service within the Annual Quality Assurance Assessment which was provided by the manager. What the care home does well Peoples needs are identified before going to the home and reflected in their support plans. People can make their own choices, take risks and have an active independent lifestyle. Meals are provided which is based on Care Homes for Adults (18-65 years) Page 7 of 29 peoples needs and preferences. Medicine management promotes the peoples safety. Peoples views are listened to people said they feel safe in the home. The home is clean and pleasant. people are supported by competent and qualified staff who are recruited appropriately. What has got better from the last inspection People are now involved in the care planning process. Medications management is now effective in promoting the safety of people. Policies and procedure have now been updated effectively. Care Homes for Adults (18-65 years) Page 8 of 29 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Steve Keeling 33 Greycoat Street London SW1P 2QF 02079792000 Care Homes for Adults (18-65 years) Page 9 of 29 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 set out 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 Adults (18-65 years) Page 10 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Effective needs assessments are performed prior to service users being admitted to the home to ensure service users needs can be identified and met. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment states Before any service user come to live at the care home there is a five month transition period, they can stay over and become familiar with the home, after this period they can choose if they wish to live here, at all times the service users are made aware of what we have to offer as a service provider. We examined the pre admittance assessment of the two service users in residency at the home. both service users have been at the home for several years but assessments from Social Services were retained on file to show that effective pre admittance assessment had been performed. Intermediate care is not provided at the home. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Service users are assured that their changing needs and aspirations are reflected in their support plan. Service users are supported to make their own choices, take risks and have an active independent lifestyle. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessments states Each service user has a care plan drawn up with them, their family and professional bodies. Each service user has a key worker and a one to one worker to enable them with their choices. The Annual Quality Assurance Assessment also states The care plans are reviewed by the service user and any other professionals at least twice a year and any changes are made. Risk assessments are carried out on all service users to enable them to lead as normal a like as possible. Records were available to support this. We examined the care planning documentation of the two service users in residency at the home. The records showed that the care plans would benefit from being more person centred but were developed in consultation with service users and contained sufficient information to inform care staff of the service users needs. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: The Have your Say survey asked people Do you make decisions about what you do each day. The respondents stated I ask to go out and I am taken and If i want to do something the staff always try to help me do it. On the day of the inspection we asked all the service users if the staff respect their decisions as to how they spent their days, responces included yes they do and yes its lovely here. We can go to the shops for a trip out our just stay in and watch television which we like. One service user stated I help to do the gardening sometimes, which I like. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Service users can participate in a good range of social activities. Service users rights and responsibilities are upheld and they can maintain contact with their family and friends as they wish. A well-balanced menu is provided which is based on service users needs and preferences. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment states The service users family and friends are encouraged to visit whenever they can and service users phone them whenever they want to. All service users have one to one support workers who take them out into the community and they attend the cinema, library, shops, pubs, wherever they would like to go. Service users have four meals per day, snacks are available throughout the day together with hot and cold drinks as required. The Have your Say questionnaire asked people Can you do what you want during the day, evening and weekends and Do the carers listen and act on what you say. Both respondents stated yes and comments included The staff are very nice to us Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: and The staff are good. All the service users stated they enjoyed the social activities provided at the home and within the broader community and confirmed that holidays are provided to Skegness, and Turkey. Service users also confirmed that they attend the cinema, go for meals or drinks at a local pub and regularly visit the Newark shopping area . A small, secure and well presented garden area is available and service users confirmed that it is used in the summer months for social activities. Service users were asked if they liked to meals provided at the home both both stated the food is very good and said they contribute to the development of menus as peoples preferences in relation to food provision is discussed at residents meetings, together with social activities and holidays. On the day of the inspection the main meal was roast pork with all the trimmings. Both service users stated that a Sunday roast provided every week which they particularly enjoy and on Saturday mornings a full English breakfast is provided. The kitchen area and dining room is very well maintained and the home has been recently awarded a Five star (excellent) food hygiene in 2008 from Newark and Sherwood Council. An open door policy is encouraged by the manager and staff at the home . Both service users confirmed the open door policy and said that their friends and relatives are always made very welcome. A visitor to the home also confirmed the open access and said I am always made very welcome, all the staff are nice and welcoming, they do wonders with the residents. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Service users health and personal care support is of a good standard. Medicine management promotes service users safety and independence. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment stated Victoria house provides sensitive and flexible support, we can help service users to have control over their own independence and dignity and they are supported in relation to privacy. All service users have their own doctor, dentist and optician. All service users can choose if they would like a bath or a shower and can choose what time they want to go to bed and what time they get up in the mornings . Information provided by the registered manager within the Annual Quality Assurance Assessment stated The service users do not self medicate and have got a care plans are in place to show this. All staff are trained in the administration of medicines. All medication is kept in a locked safe and a record of all medication coming into the home is maintained and any medication not used is recorded and returned. Records showed, and staff confirmed that appropriate training has been provided in relation to medication management. Service users medication is stored in a secure environment to promote their safety and medication administration records showed that service users medication had been administered safely. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: Support plans showed and service users confirmed on the day of the inspection that they have access to health care services from members of the multi-disciplinary health team, both within the home and the local community such as dentists, opticians, general practitioners and district nurses. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Service users feel their views are listened to and acted upon and systems are in place to protect people from abuse, neglect and self harm Evidence: On the day of the inspection all the service users stated that they felt safe and happy with all aspects of service provision. The pre inspection questionnaires asked service users Do you know how to make a complaint, both respondents stated yes and comments included I would go to the manager or one of the staff. We examined the complaints/concerns book which showed that no complaints have been made since the last unannounced inspection was performed in December 2007. The manager stated that there has not been any reported incidents of abuse whatsoever and the Commission has not made any Safeguarding Adult referrals in relation to service provision at the home. Staff training records also showed, and staff confirmed, that training in relation to Safeguarding Adults has been provided. We discussed issues relating to Safeguarding Adults with a member of staff. The member of staff had a satisfactory understanding of her roles and responsibilities in this area. The revised Nottinghamshire Safeguarding Adult procedure is now available to all staff for further guidance and reference should it be required. Care Homes for Adults (18-65 years) Page 19 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Service users live in a homely well maintained environment which is clean, pleasant and hygienic. Evidence: The Have your Say survey asked Is the home fresh and clean, both respondents stated always, comments included, The home is always clean and tidy and It is always lovely and clean and smells lovely. Information provided by the registered manager within the Annual Quality Assurance Assessment states Each service user has a clean comfortable room and bed, clean bed linen is provided on a daily basis. Service users rooms are equipped with bedside lighting , a mirror, a wash basin, seating, double wardrobe and a dressing table. The home has a policy on infection control and all the staff have received training in this area. We asked all the service users if they were satisfied with the standard of cleanliness at the home, they said that they were very happy with the cleanliness. We performed a partial inspection of the premises, which included peoples bedrooms, communal areas and the kitchen facility. All areas were very well maintained and clean, as mentioned earlier in the report the service has been awarded a five star (excellent) food hygiene standard in 2008 from Newark and Sherwood Council. Staff said that protective aprons and gloves were available and used when providing Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: people with personal care. Staff also confirmed that training in the principles of infection control has been provided to promote the safety of people. Radiator guards and window restrictors were not in place throughout the home. To address the shortfall the manager stated that work would commence with one week of the inspection date to address the shortfall. Care Homes for Adults (18-65 years) Page 21 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Service users are supported by competent and qualified staff and staff recruitment practices promotes safety. Evidence: The pre inspection questionnaires asked Do staff treat you well both respondents stated always and comments included The staff are very nice, we have good staff and The staff are always nice. Information provided by the registered manager within the Annual Quality Assurance Assessment stated All our staff are trained to a high level, they have the qualities to provide good support, they are reliable, very caring and committed to the service users. Victoria house operates a very strict recruitment process, which is based on equal opportunities to ensure the protection of our service users and service users play a very active part in the recruitment process. Staff recruitment records are well maintained and stored securely. Criminal Record Bureau checks have been obtained, together with two satisfactory references, proof of identity and the individuals qualifications. Information provided by the manager, within the Annual Quality Assurance Assessment states that Were ensure that the homes training and development plans are put into practice and all staff receive induction training. The Annual Quality Assessment also showed that 33 of the care staff have a National Vocational Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: Qualification (NVQ) level two and above in care to ensure a suitably qualified workforce is employed at the home. A member of staff who has recently attained a National Vocational Qualification in care, confirmed that a comprehensive staff-training programme is provided and said that she feels that the staff training programme is effective in providing her with the skills and knowledge to perform her duties effectively. The member of staff also confirmed that refresher training is provided on a regular basis. The manager stated that at present a staff training matrix is not in place to show when staff had received refresher training but stated that one would be formulated within two months of the inspection. All staff have been in employment at the home for several years and the recruitment practices were assessed as good at previous inspections therefore recruitment documentation was not examined on this occasion. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. Service users benefit from a well run home which takes into account service users views. The health, safety and welfare of service users is promoted and protected. Evidence: The manager has completed the degree level Registered Managers Award and is also National Vocational Qualification (NVQ) assessor. Information provided within the Annual Quality Assurance Assessment states The manager gives a clear sense of direction and leadership to all staff and service users so they are able to carry out the aims and purpose of the home. The manager ensures safe working practices to promote and protect the health and safety of service users and staff. The pre inspection questionnaires asked service users Is there anything else you would like to tell us. Comments included I like living in this house, everyone is nice, and the house is nice, it is nice and clean and the staff are nice. Members of staff spoken with stated that they feel supported and stated that the manager is very competent in performing her managerial duties to the full. Staff also Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: confirmed that the manager initiates formal staff appraisals on a yearly basis. Informal staff supervisions are performed but at present the supervision sessions are not recorded. Information provided within the Annual Quality Assurance Assessment states We have regular meetings, the manager is open to any views and suggestions that staff and service users make. Records showed and service users confirmed that the monthly meetings take place which provides them with a forum to discuss meal provision, social activities, and holidays. Policies and procedures are available in the managers office and members of staff confirmed that the policies could be assessed at any time for reference and guidance. Information provided within the Annual Quality Assurance Assessment showed that peoples health, safety and wellbeing is promoted by the provision of effective routine maintenance. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes  No  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 Adults (18-65 years) 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 Description 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 Description Timescale for action 1 24 23 The Registered person must 30/06/2009 ensure that risk assessments are performed in relation to the lack of radiator guards and window restrictors. To ensure that peoples safety is promoted within the homes environment, Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 6 35 The current care planning format could benifit from being more person centered. The registered person could formulate a staff training matrix to show the training provided to care staff ate the home. The registered person could initiate formal staff supervision process. Page 27 of 29 3 35 Care Homes for Adults (18-65 years) Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone : or 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. 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