Care Home: Victoria Nursing Home

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What the care home does well Thorough pre-admission assessments are undertaken before a person moves into the home and care plans demonstrate that peoples needs are central to the service being provided. This ensures that their needs will be met and that the home will be a good place for them to live. Management and staff treat people as individuals and respect their rights to make choices and decisions and to lead their lives in a private and dignified manner. People living in the home are provided with regular opportunities to express their views on the quality of the service being provided and suggestions for improvement inform the future development of the service. People have access to a range of opportunities for leading healthy, active and fulfilling lifestyles according to their personal preferences. Staff are regarded highly by the people using this service. One person commented that she gets on well with the staff and that they are kind and caring. This was also confirmed by our observations of interactions between staff and the people they cared for. Equipment used in the home is maintained and serviced regularly, risks are managed well and staff are knowledgeable about what action they must take to keep people safe from harm. What has improved since the last inspection? We found evidence that two of the three outstanding requirements had been addressed since our last visit. Improvements had been made to the way medication was administered to ensure that the system in place was safe. This means that people receive their medication exactly as prescribed by their doctor. Staff working in the home told us that they had regular opportunities to discuss their work in supervision sessions with their manager. What the care home could do better: During our last visit we highlighted the need for the home`s Statement of Purpose to be reviewed and updated to include changes to the home`s registration. We could not confirm that this had been done as a current Statement of Purpose could not be located during this visit. It is important that people enquiring about this home are given accurate and up to date information about the service and facilities provided. Improvements should be made to garden paths to remove moss growth and minimise the potential risk of injury from slips and trips. Additionally, sufficient garden furniture should be provided to meet the leisure needs of people living in the home. In relation to recruitment and fire safety, certain documents could not be located during our visit. Consequently we were unable to confirm that these specific recordswere accurate and up to date. Records should be available at all times to provide evidence that the interests of people living and working in the home are safeguarded from harm. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Victoria Nursing Home 9 Anson Road Victoria Park Manchester M14 5BY     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: Val Bell     Date: 0 9 0 7 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. 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. 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 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 Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 Older People Page 3 of 27 Information about the care home Name of care home: Address: Victoria Nursing Home 9 Anson Road Victoria Park Manchester M14 5BY 01612240302 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) : victorianursing@btconnect.com Homesend Limited care home 21 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 21 21 The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Dementia - Code DE Mental disorder, excluding learning disability or dementia - Code MD The maximum number of people who can be accommodated is: 21 Date of last inspection Brief description of the care home Victoria Nursing Home was registered in July 2002 to provide accommodation with nursing care for a maximum of 21 older people with mental health needs. The home is operated by Homesend Limited with Mr Adrian Webb the responsible individual and Tony McVitty the registered manager. The home is situated in the Victoria Park area of Central Manchester close to local shops, public houses, Manchester Royal Infirmary and a range of social and leisure amenities. The home is close to public transport routes to the city centre and south Manchester. The home is a large converted semi-detached building, adjoining Surrey Lodge Health Care Homes for Older People Page 4 of 27 Brief description of the care home Centre and set within its own grounds. The home offers accommodation on three floors with all communal spaces being on the ground floor. The accommodation comprises of single and double bedrooms and has a choice of lounges, where people can relax, listen to music, watch television or entertain visitors. There is no set fee charged for admission to this home as each care package is individually priced according to the persons assessed needs. Additional charges are made for hairdressing, newspapers and clothes. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection, which included a visit to the home. The visit was unannounced, meaning that the manager was not informed that we were coming to visit. During our visit we spent time talking to people living in the home and joined a group of people for lunch. We also had conversations with the registered manager and staff working in the home that day. We also examined several documents, systems and procedures used in the home and we undertook a tour of the premises during our visit. The provider had completed and returned to the Commission an Annual Quality Assurance Assessment (AQAA). This is a self-assessment of how well the registered Care Homes for Older People Page 6 of 27 persons consider the service to be meeting the National Minimum Standards for Older People. What the care home does well: What has improved since the last inspection? What they could do better: During our last visit we highlighted the need for the homes Statement of Purpose to be reviewed and updated to include changes to the homes registration. We could not confirm that this had been done as a current Statement of Purpose could not be located during this visit. It is important that people enquiring about this home are given accurate and up to date information about the service and facilities provided. Improvements should be made to garden paths to remove moss growth and minimise the potential risk of injury from slips and trips. Additionally, sufficient garden furniture should be provided to meet the leisure needs of people living in the home. In relation to recruitment and fire safety, certain documents could not be located during our visit. Consequently we were unable to confirm that these specific records Care Homes for Older People Page 8 of 27 were accurate and up to date. Records should be available at all times to provide evidence that the interests of people living and working in the home are safeguarded from harm. 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 Older People Page 9 of 27 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 10 of 27 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. Systems are in place to assess and monitor individual needs, ensuring that a suitable service is provided, based on personal needs and preferences. Evidence: There was one requirement in this section that was outstanding from our last inspection visit in July 2007. This required a review of the homes Statement of Purpose to ensure that it accurately reflected a change in the homes registration category. We were unable to confirm that this had been done, as a current copy of the Statement of Purpose could not be located during this visit. We looked at the process for assessing the needs of people being admitted to the home by examining the care records belonging to three people currently accommodated. We found evidence that the good practice identified at the last inspection had been maintained and further improved. Comprehensive assessments Care Homes for Older People Page 11 of 27 Evidence: had been undertaken to identify each persons needs and how these would to be met. Particular attention had been paid to recording risks, mental capacity and cultural and religious needs. This provided evidence of best practice in respecting and meeting the diverse needs of people using this service. This home did not offer an intermediate care service. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this nursing home have their needs met and their care is provided in a manner that protects their privacy and dignity. Evidence: We examined three care plans to determine if the needs of people living in the home were being met. Care plans had been drawn up from information contained in the needs assessments. It was evident that people had been fully involved in this process by recording their views on how they preferred their care and support to be provided. Careful attention had been paid to providing clear guidelines to staff on what they must do to keep people safe from harm. Daily records provided evidence of the care and support that had been provided exactly as agreed in the care plans. This system of care planning demonstrates that staff respect the individual nature of peoples needs and that the care they receive is person-centered. People living in this home receive the right amount of support to ensure that their health care needs are met. Records detailed the outcome of appointments with health Care Homes for Older People Page 13 of 27 Evidence: care professionals and the action that had been taken to follow their guidance. Several of the care plan documents had not been signed or dated. This is a minor shortfall, but important in providing evidence to demonstrate that care plan information is up to date. We looked at the medication records for the three people whose care plans we examined. The records were accurate and up to date and provided evidence that people were receiving their medication exactly as prescribed by their doctors. The requirement made at the last inspection to ensure that medication was being administered safely had been addressed. We found evidence of this by observing the administration of lunch-time medication. Two people living in the home told us that their care and support is provided with respect and in a dignified manner. One person said, I like living here. Staff are friendly and helpful. I get on well with all of them. We observed that interactions between staff and the people accommodated were respectful with staff offering support in a sensitive and caring way. Care Homes for Older People Page 14 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service receive the support they need to meet their expectations and preferences regarding their daily lifestyles. Evidence: Care plans and conversations with people living in the home provided evidence that the excellent standard of activities and community contact had been maintained since the last inspection. One person told us she enjoyed the arts and crafts sessions and going out for walks to the shops. The outcome of participation in activities had been written down for each person, providing evidence that social, leisure, religious, cultural and relationship needs were being met according to their personal preferences. Staff were providing the right level of support to people in making decisions and choices that were important to them. We sat down for lunch with four people living in the home. There was a choice of two cooked meals and desserts. The meals were nourishing and attractively presented. We observed a member of staff assisting a person to eat their meal. This was done in a sensitive and unobtrusive manner. The people we sat with told us that they enjoy the meals provided and that drinks and snacks were available throughout the day and Care Homes for Older People Page 15 of 27 Evidence: night. Care Homes for Older People Page 16 of 27 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. Good safeguarding procedures help to ensure that people remain safe in this home. The complaints procedure is clear and accessible meaning people feel listened to and taken seriously Evidence: People using this service had access to a system for expressing their concerns or complaints. Since the last inspection the home had received one complaint. Records provided evidence that this had been fully investigated and resolved within the timescale prescribed by the complaints procedure. The Care Quality Commission had not received any complaints about this service. Three people accommodated in the home said they were confident that staff would respond appropriately to their concerns. The welfare of people living in this home was protected by robust policies and procedures that safeguard people from harm. Staff had received training in how to recognise the signs and symptoms of abuse and what action they must take to report suspicions or allegations of abuse. No safeguarding referrals had been made in relation to people using this service during the previous twelve months. Care Homes for Older People Page 17 of 27 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. Improved outdoor facilities would provide the people living in this home with more choice in how they spend their leisure time. Evidence: We undertook a tour of the building and its grounds to assess health and safety, cleanliness and hygiene and the facilities available to people living in the home. Significant improvements had been made to the environment by redecorating, replacing some furniture and the addition of attractive pictures in lounges and corridors. Suitable measures were in place to ensure that private and communal space was safe, clean and hygienic. Laundry and kitchen facilities were situated in the basement. A door leading off the laundry was not closing fully into its rebate. Action should be taken to address this to prevent the risk of smoke inhalation in the event of a fire in the basement. On the day of our visit several people living in the home were enjoying the nice weather in the garden. This was an enclosed area comprised of tarmac paths and a large lawn. The paths were heavily infested with moss growth, which may present slipping and tripping hazards in wet weather. The garden furniture was old and covered in grime and algae and there were insufficient tables and chairs to meet the Care Homes for Older People Page 18 of 27 Evidence: needs of the people living in the home. The self-assessment completed by the owner did not mention specific plans to improve the garden facilities. Action should be taken to improve this area to make it safe and provide sufficient garden furniture to meet peoples leisure needs. Care Homes for Older People Page 19 of 27 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. People living in this home are supported by a knowledgeable and skilled team of staff. However, incomplete recruitment records potentially placed the health and welfare of the people accommodated at risk. Evidence: On the day of our visit, sufficient numbers of staff were on duty to meet the needs of people living in the home and rotas provided evidence that this level of staffing had been maintained. Two support workers told us about the training courses that they had attended in the previous twelve months. They spoke respectfully about the people they supported and were knowledgeable about each persons specific needs. One of the support workers had achieved a Level 2 National Vocational Qualification in Mental Health and the second support worker was currently studying for this qualification. Both staff confirmed that they received good support from the management and that effective teamwork had resulted in positive outcomes for people using the service. We looked at the personnel files belonging to two members of staff that had been recruited since our last visit. Required pre-employment checks had generally been undertaken, although we could not locate two written references for each member of Care Homes for Older People Page 20 of 27 Evidence: staff. We were surprised to learn that the manager had little involvement in the recruitment process, which was undertaken by the registered providers, who were on holiday at the time of our visit. We asked to be contacted when the missing references had been located. It was disappointing that we had not been contacted about this by the time of writing this report. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management systems do not always ensure optimum efficiency in managing fire safety and recruitment. However, people living in the home were confident that the home was being managed in their best interests. Evidence: The registered manager was present throughout this inspection visit. The registered providers were heavily involved in the day-to-day management of this home, taking responsibility for specific tasks such as recruitment and health and safety. The providers were on holiday at the time of our visit and this highlighted some shortfalls in the continuity of management in the home. As reported in the section on Staffing the registered manager had little involvement in the recruitment of staff, which meant that he was not fully conversant with locating some of the recruitment records. Similarly, it was of concern that the manager could not locate the fire records during our visit, so we could not establish if the required fire safety checks had been kept up to date. We asked the manager about fire training and it appeared that he had not Care Homes for Older People Page 22 of 27 Evidence: received a training update for some considerable time. The manager and other senior staff in charge of each shift must have up to date knowledge of fire safety procedures and access to the fire records at all times. This is to ensure that the correct procedures are followed to safeguard people living and working in the home in the event of a fire. This service had a comprehensive quality assurance system in place. This included listening and responding to the views of people using the service and their representatives. Regular audits had been undertaken of systems used in the home so that corrective action could be taken where shortfalls were identified. The service had also registered with Investors in People and were working towards achieving this award. The people we spoke to during our visit all expressed their satisfaction with the care and support they received. They talked fondly of the staff that supported them and they felt confident that the home was being run in their best interests. This service did not accept appointeeship for benefits purposes. People needing support to manage their personal finances had the option of assistance from family members or the client affairs department of the local authority. Day-to-day expenditure was accounted for in line with Manchester City Councils protocols. We examined a sample of health and safety records, including the maintenance of gas and electrical equipment and the servicing of the lift and hoists used in the home. This provided evidence that equipment used in the home had been maintained to a good standard. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R 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 1 1 4 The Statement of Purpose 13/08/2007 must be reviewed and updated to reflect the recent variation in the homes registration category. This will ensure that people referred for admission to the home are provided with accurate and up to date information. A copy of this amended document must be forwarded to the Commission. Care Homes for Older People Page 24 of 27 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 1 6 A current copy of the homes 26/08/2009 Statement of Purpose must be forwarded ro the Care Quality Commission. To provide evidence that people enquiring about this service are being provided with accurate and up to date information. 2 38 18 Senior staff working in the home must have current knowledge of fire safety procedures and have access to fire safety records at all times. To ensure that correct fire safety procedures are followed and that these safeguard the health and welfare of people living and working in the home. 09/09/2009 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 Care Homes for Older People Page 25 of 27 improving their service. No. Refer to Standard Good Practice Recommendations 1 19 The garden paths should be made safe and sufficient garden furniture should be provided to meet the leisure needs of people living in the home. Care Homes for Older People Page 26 of 27 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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