Care Home: Victoria Nursing Home

What the care home does well People who are considering moving into the home benefit from having an assessment of their needs so that they can be sure the home can meet these needs. People are encouraged to look around before agreeing to move in. A visitor told us "we had all of the information needed before we chose this Home" Care plans are developed within the first few days of admission for everyone living at the Home. People`s identified needs are met and those spoken to were happy with the care Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 and the way in which care is provided. People have access to advice from health professionals where they need it, so their health needs can be met. People said "I see the Dr or dentist whenever I need to", "the Home provides friendly and efficient staff", "I get my tablets on time every day" People living in the home benefit from having a balanced and nutritious diet. Assistance to eat meals is provided in a sensitive way. Staff were aware of individual likes and dislikes. People said, "the food I get, I like", "I have enough to eat all of the time but you can ask for more", "the food is good, there is too much of it". The home`s complaints policy is on display for all to see. People living in the home were confident that their concerns would be listened to and acted upon. People said "I have no complaints or worries, I have no problems, staff would sort them out if needed I am sure", "If I had any worries I would speak to staff and I am sure they would sort them out". There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. Accommodation is safe, clean, well maintained and comfortable. The manager is aware of maintenance issues, which are addressed promptly. One person said, "I like my room, it is always clean" There are sufficient numbers of staff on duty to meet the needs of people living in the home. People said "staff treat you with respect", "staff come quickly when they are called", "staff are all kind and respectful, they are never rude, never rush you and I have no problems". What has improved since the last inspection? This is the first inspection since the Home became registered with a new owner in January 2009. What the care home could do better: Care plans should be developed to meet all of the identified needs of people living at the Home. They should be reviewed and updated on a regular basis and include detailed information to guide staff regarding the action they are to take to meet these needs. Arrangements should be made for each person living in the home to engage in meaningful and stimulating occupation that matches their ability and cultural preferences. This should ensure that people living in the home are stimulated and improve their quality of life. People should be made aware that there is a choice of food available for the main lunchtime meal. People should also be given a choice of whether sauces or gravy is added to their meal. Staff should undertake training regarding the protection of vulnerable adults.Victoria Nursing HomeDS0000073210.V376170.R01.S.docVersion 5.2Criminal records bureau and protection of vulnerable adults checks must be available for all staff. This helps the Home to ensure that only those people suitable to work with vulnerable adults are employed at the Home. A hand wash sink must be made available in the laundry to ensure infection control procedures are adhered to. Staff training must be undertaken on a regular basis to ensure that the workface have the skills and abilities to be able to meet the needs of those under their care. This includes mandatory training such as infection control, protection of vulnerable adults and food hygiene. Systems should be in place for the review of working practices (including staff supervision) and quality of service delivered. This should make sure that the home is run in the best interests of people living in the home. The fire risk assessment should be updated and include details of how to minimise risk for residents who prefer to have their bedroom door left open. This should safeguard people living in the home. Key inspection report CARE HOMES FOR OLDER PEOPLE Victoria Nursing Home Victoria Nursing Home 31 Kenilworth Road Leamington Spa Warwickshire CV32 Lead Inspector Deborah Shelton Unannounced Inspection 15th June 2009 09:45 DS0000073210.V376170.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria Nursing Home Address Victoria Nursing Home 31 Kenilworth Road Leamington Spa Warwickshire CV32 01926 425629 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) The Albemarle Rest Home Limited Manager post vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) 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 (OP) 23 The maximum number of service users to be accommodated is 23. 2. Date of last inspection Brief Description of the Service: Victoria Nursing Home is a privately owned care home situated on a main road close to the centre of Leamington Spa. The home lies on a bus route and is easily reached. The home provides care for 23 elderly residents requiring nursing care. Accommodation is provided over three floors with lift access to all floors. The home has a lower ground floor where the kitchen is situated and other staff facilities, also a large cellar where the laundry is situated. There are 15 single occupancy rooms and ten of these have en-suite bathrooms, and a further 3 shared rooms. There is a lounge on the ground floor and a smaller lounge on the second floor. There is no dining room. The home has a small and secluded garden to the side of building. There is ample parking available. At the time of the inspection visit the there was no written information available about fees. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This is Victoria Nursing Home’s first inspection since it was registered under new ownership. Registration was granted in January 2009. This was a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. The visit took place on Monday 15 June 2009 between 9.45am and 6.20pm. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. An Annual Quality Assurance Audit (AQAA) was completed by the manager and returned to us within the timescale required. This document gives information on how the Home thinks it is performing, changes made during the last twelve months, how it can improve and statistical information about staffing and residents. During this Key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Time was spent sitting with people in the lounge watching to see how they were cared for and how they spent their day. Discussions were held with people who use the service, staff and visitors to the Home. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Three people living in the home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service; this helps us to see whether the service meets individual needs. Seven people living at the Home and two staff returned survey forms to us before this inspection visit; their comments are included throughout this report. What the service does well: People who are considering moving into the home benefit from having an assessment of their needs so that they can be sure the home can meet these needs. People are encouraged to look around before agreeing to move in. A visitor told us “we had all of the information needed before we chose this Home” Care plans are developed within the first few days of admission for everyone living at the Home. People’s identified needs are met and those spoken to were happy with the care Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 6 and the way in which care is provided. People have access to advice from health professionals where they need it, so their health needs can be met. People said “I see the Dr or dentist whenever I need to”, “the Home provides friendly and efficient staff”, “I get my tablets on time every day” People living in the home benefit from having a balanced and nutritious diet. Assistance to eat meals is provided in a sensitive way. Staff were aware of individual likes and dislikes. People said, “the food I get, I like”, “I have enough to eat all of the time but you can ask for more”, “the food is good, there is too much of it”. The home’s complaints policy is on display for all to see. People living in the home were confident that their concerns would be listened to and acted upon. People said “I have no complaints or worries, I have no problems, staff would sort them out if needed I am sure”, “If I had any worries I would speak to staff and I am sure they would sort them out”. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. Accommodation is safe, clean, well maintained and comfortable. The manager is aware of maintenance issues, which are addressed promptly. One person said, “I like my room, it is always clean” There are sufficient numbers of staff on duty to meet the needs of people living in the home. People said “staff treat you with respect”, “staff come quickly when they are called”, “staff are all kind and respectful, they are never rude, never rush you and I have no problems”. What has improved since the last inspection? What they could do better: Care plans should be developed to meet all of the identified needs of people living at the Home. They should be reviewed and updated on a regular basis and include detailed information to guide staff regarding the action they are to take to meet these needs. Arrangements should be made for each person living in the home to engage in meaningful and stimulating occupation that matches their ability and cultural preferences. This should ensure that people living in the home are stimulated and improve their quality of life. People should be made aware that there is a choice of food available for the main lunchtime meal. People should also be given a choice of whether sauces or gravy is added to their meal. Staff should undertake training regarding the protection of vulnerable adults. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 7 Criminal records bureau and protection of vulnerable adults checks must be available for all staff. This helps the Home to ensure that only those people suitable to work with vulnerable adults are employed at the Home. A hand wash sink must be made available in the laundry to ensure infection control procedures are adhered to. Staff training must be undertaken on a regular basis to ensure that the workface have the skills and abilities to be able to meet the needs of those under their care. This includes mandatory training such as infection control, protection of vulnerable adults and food hygiene. Systems should be in place for the review of working practices (including staff supervision) and quality of service delivered. This should make sure that the home is run in the best interests of people living in the home. The fire risk assessment should be updated and include details of how to minimise risk for residents who prefer to have their bedroom door left open. This should safeguard people living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Victoria Nursing Home DS0000073210.V376170.R01.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 Nursing Home DS0000073210.V376170.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was assessed Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three people were chosen to case track during this inspection. This involved talking to the person and their family (where possible), looking at their care files and any related documentation, talking to staff about the care that they provide and looking at living areas and the facilities available. One of the people case tracked had recently moved in to the Home. This person’s care file was reviewed to see what pre-admission assessment processes take place. The manager or senior nurse usually undertakes pre-admission assessments. A visit is conducted to the person who wishes to move into the Home and a care needs assessment Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 10 is carried out. This gives the Home information about the person to enable them to decide whether they would be able to meet their needs. Standardised documentation is used to record information. The needs assessments seen contained brief information about people’s needs and abilities and any resources, such as equipment needed to help provide care. Care plans are developed within a few days of admission using the information obtained during the pre-admission process. One relative confirmed that a member of their family had visited the Home before their mother was admitted. They said that they had received enough information about the Home to help them make an informed choice about their mother moving in. We sent surveys to the people who live at Victoria Nursing Home and seven people responded, five people said that they received enough information to help them decide if the Home was the right place for them before they moved in. Two people could not remember. A resident who had recently moved in confirmed that they had settled in well and that everyone had made lots of effort to help them settle. From documentation seen, discussions with the manager and a visitor to the Home, it was noted that pre-admission processes are satisfactory. Sufficient information is obtained about people using the Home’s own pre-admission assessment and information sent by either the hospital or social services. A discussion was held regarding contracts of residency. It was noted that these are in the process of being amended due to the new ownership of the Home. At the time of inspection the manager did not have access to new contracts/terms and conditions of occupancy between the Home and people who move in but gave assurances that these are now in place. The contract between social services and the Home was seen for one person and other copies were available for review. The Home’s statement of purpose and service user’s guide were seen. These documents are being updated to include information regarding increases in staffing levels, changes in management and ownership and any other changes that have taken place since the Home changed ownership. Victoria Nursing Home DS0000073210.V376170.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is good. People have good access to a wide range of health professionals which results in their healthcare needs being met, they are treated with respect and their rights to privacy and dignity are maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files of the three people being case tracked were reviewed. Each file contained a pre-admission assessment completed by the Home, which gave brief details of care needs. An assessment and review booklet was available for each person. This booklet contained risk assessments and an evaluation of individual’s dependency levels. Each area was reviewed on a monthly basis and gave a clear picture of people’s changing needs. Information regarding the number of staff required to provide assistance and equipment in use was also recorded for the areas being monitored. This booklet did not record a Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 12 detailed care plan, care plans are recorded in the nursing record system. Care staff spoken to confirmed that they had access to these books but used the care plans in the nursing records each day to give them the information they need to care for people. Plans of care were seen, these documents had been developed for some identified needs but not for others, for example there was no care plan regarding catheter care, nutritional needs or behavioural needs. However, staff were taking action and equipment was in use to meet these needs. Staff spoken to were aware of the action to take but could not give specific information regarding timescales for action. Some care plans did not contain enough information for staff to be able to care for the individual, for example one care plan regarding poor diet records “to try to ensure a well balanced diet – encourage diet and fluid offer choices”. This does not record that the person has a soft diet. An information booklet regarding the consistency of food was kept in another folder but the Home had not developed their own plan of care. It was also noted during discussions with staff that this person does not have milk or white bread. There was no information regarding this in any care documentation seen. Information in one care plan had not been updated and was therefore out of date. Daily records are completed per shift and record the action taken by staff to meet individual’s needs. New healthcare needs are recorded and health is monitored. The daily records for one person who was being nursed in bed required staff to check on him regularly. When spoken to, staff were aware of the need to check on this person but could not state timescales. There was no care plan to tell staff how often they are to check on this person or the reasons that they are to do so. Two of the three records seen identified that these people were losing weight and that food supplements were to be given. There was no care plan that detailed how often these supplements were to be given or what they were. There was no evidence of any other action taken to monitor the weight loss, i.e. food intake charts. The manager said that they are doing everything they can to maintain people’s weight. The Home does not use body maps to record any areas of bruising or sores. There were no turn charts in place for those people being nursed in bed who would be unable to move themselves. These people should be turned on a regular basis to prevent the development of pressure areas. There was no fluid intake or fluid balance charts available. The care file of one person observed to have bedrails in place on their bed did not contain a risk assessment for their use. There was therefore no documentary evidence to demonstrate that the use of bed rails is the safest way of maintaining this person’s safety. Family members had signed to confirm their agreement to the use of bed rails. The manager said that people are offered the choice of having male or female carers to provide personal care, however there was no documentary evidence to demonstrate this. Two people were asked about this and they could not remember being offered this choice. Both people said that they did not mind male or female staff caring for them. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 13 Relatives/residents have not signed documentation to demonstrate that they are involved in the care planning process. However, all of the people spoken to during the inspection were happy with their care and the way in which it was provided. Our survey asked people if they receive the care and support that they need. Four people replied usually and three people said always. One person also commented “I feel I am looked after well”. We also asked if the Home makes sure that people get the medical care that they need. Two people did not respond to this question, two people said usually and four people said that they always receive the medical care that they need. One person spoken to during the inspection said that she was happy with the care given, stated that care staff are lovely, and in general she sees the GP whenever she needs. Other people said “I am well cared for”, “I see the GP, optician and chiropodist whenever I need to, I have just had new glasses”. Discussions with the manager, senior nurse and care staff confirmed that they are aware of the needs of everyone under their care. The manager was aware that care plans need updating and said that changes to the care planning system are continuing. Medication systems and practices were reviewed. It was noted that key custody practices are safe and that medicines are stored appropriately in locked cupboards and a medicine fridge. A new medication trolley has recently been bought but is not yet in use. The nurse on duty explained that they are considering purchasing medicine trolleys for each floor to make medication administration less time consuming. Records are available to demonstrate that the medicine fridge temperature is taken on a daily basis and is within the required limit, records also show that regular cleaning and defrosting of this fridge take place. Medicine administration records (MAR) for the three people being case tracked were seen. One error was identified and was discussed with the manager and senior nurse. All other records were completed correctly and stocks of medicines held balanced with records. The medicine cupboard was clean and well ordered. There were no stocks of excess medication. A contract is in place for the safe disposal of unused medication. Controlled drug records had been completed correctly and stocks of controlled drugs balanced with records held. It was noted that sleeping tablets are being stored in the controlled drugs cabinet. Items other than controlled drugs should not be stored in this cabinet. The systems for ordering and receipt of medication were discussed. The Home does not obtain copies of the original prescriptions to check against medication received and medication administration records. The manager was advised that copies of all prescriptions should be available. At this inspection safe systems were in place for the management and administration of medicines in the home. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 14 Five people were spoken to during this inspection. Each person confirmed that they are treated with respect and that staff are patient and caring. People were dressed appropriately for the time of year in clean clothing. Their hair was neatly brushed and nails clean. Staff appeared to have a good relationship with those under their care and conducted moving and handling activities maintaining the dignity of those people involved. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is adequate. People are encouraged to keep in contact with family and friends and visiting is flexible. There is limited evidence to demonstrate that the lifestyle experience in terms of social and leisure activities meets the needs of those that live at the Home. This judgement has been made using available evidence including a visit to this service EVIDENCE: An activities list is on display in the lounge area. An exercise to music session takes place each Wednesday. Some of the people spoken to join in this activity and others said that due to limited mobility or other health reasons they are not able to. People also said that staff cut their nails and chat to them and sometimes just pop into their room to see how they are and have a chat. Staff said that when they have time they play cards or do crosswords with some people. Brief information regarding interests such as watching the television, reading magazines were recorded in care files. On the day of inspection people were occupying themselves with activities of their choice, this included listening to classical music on the radio, reading magazines, chatting or watching the television. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 16 Our survey asked if the home arrange activities that they can take part in if they want. One person did not answer this question, one said sometimes, one said usually and four people said always. Some of the people spoken to were satisfied with the activities made available to them, one gentleman said that staff had brought another gentleman to his room recently for a chat and he had enjoyed that. Staff said that those people who chose to stay in their rooms often have visits from other people living at the Home and they sit and chat amongst themselves. However, one person commented that there was nothing to do and another said that they would like to go to the lounge occasionally. There was no documentary evidence to demonstrate that regular activities suited to the wants and needs of those that live at the Home are provided. Religious needs were discussed with the manager and it was noted that a religious service takes place, which is organised by the senior nurse. Two of the six people spoken to expressed an interest in attending religious services, one person said “there is a church service which is good”, whilst another person said “I don’t think there are any church services but if there were I would really like to join in”. There was limited documentary evidence in care files to demonstrate that likes, dislikes and personal preferences are taken into consideration. The manager said that people are asked if they would prefer their personal care undertaken by male or female staff but this is not recorded. One care file seen recorded the person’s preferred time of going to bed. All of the people spoken to said that they are able to choose when they get up in the morning, go to bed at night, what clothing they wear, and where they spend their day (apart from one person who said that they would like to go to the lounge occasionally). Everyone said that their care needs are met in a way which suits them and they were happy with the care given. Visitors were seen in the lounge and in people’s bedrooms and visitors spoken to confirmed that they are able to visit at any time. People spoken to were not aware of any restrictions regarding visitors to the Home. Visitors said that they are always made welcome and offered refreshments. They also said that they are kept up to date regarding the health and welfare of their loved ones. The lounge on the ground floor has a dining table and chairs available for use by a small number of people. The five people sat in the lounge at lunchtime were given their meals ready plated, served on a tray, others ate their meals in their bedroom. A small adjustable table was available for all people who ate their meal in the lounge. Staff assisted two people in the lounge to eat their meals. Staff were patient and assisted people in a sensitive manner. The manager reported that people are offered a choice of meal on a daily basis and gave an example of one resident who does not like fish so has an alternative each Friday. However, those people spoken to were unaware that they had a choice of the main meal. Two people said that they could have different fillings in their sandwiches for the evening meal and confirmed that you are sometimes given a choice in the evening but none were aware of the choice available at the main lunchtime meal. Everyone was happy with the food served and said it was tasty and there was plenty. One person commented that they Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 17 did not really like gravy. The meal served on the day of inspection had gravy already on and people were not seen to be given a choice of whether they liked gravy or not. Four of the people who responded to our survey said that they always like the meals at the Home, two people said that they usually like the meals and one person did not answer this question Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have not received any complaints about this service since the new owners took over. The manager confirmed that they have not received any complaints. The complaints policy is on display in the Home. Not everyone who responded to our survey was aware of how to make a formal complaint. People spoken to on the day of inspection said that they had no worries or concerns. One person said “if I had any problems I would soon shout out”, another person said that they would speak to the manager or any one of the staff and they were sure they would sort out any problems. The manager confirmed that they have a log book to record any complaints but as they have not received any this is empty. Care staff said that they would report any concerns received directly to the senior member of staff on duty. There have been no adult protection issues at this Home since the new owners took over. The Home have policies and procedures regarding adult protection which according to Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 19 information received on the annual quality assurance assessment document filled in by the Home, were updated in January 2009. Staff spoken to were aware of the action to take if they witnessed or suspected abuse. They said that they would report continued abuse, which had already been reported to the Home, to the police to ensure that action was taken. Staff said that no forms of abuse would be tolerated at this Home. Staff said that they had not undertaken protection of vulnerable adults training recently. Records seen and discussions with the manager confirmed that staff have not undertaken this training. The manager said that update training is being booked in the near future. Criminal records bureau checks (CRB) for staff were discussed with the manager and it was noted that not all staff have CRB or protection of vulnerable adults checks available. These are used to ensure that staff have no criminal or adult protection issues that may affect their ability to work with vulnerable adults. The manager confirmed that protection of vulnerable adults checks will be undertaken immediately for new staff due to start at the end of this week. Risk assessments should be completed for those staff working in the Home before their CRB is received. The manager is aware that these staff should not work unsupervised. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is good. People benefit from living in a safe, clean and well maintained environment. This judgment has been made using available evidence including a visit to the home. EVIDENCE: Victoria Nursing Home is not purpose built but has been adapted to suit the needs of those living there. The Home is located close to the centre of Leamington Spa and is therefore close to shops, public houses and bus services. On the day of inspection the Home was clean and hygienic and no unpleasant odours were noted. Furnishings, fittings and décor were in a good state of repair. Five people were sat in the communal lounge on the morning of inspection; the manager confirmed that the remaining people usually stay in their bedroom. Bedrooms seen were Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 21 large, bright and airy. People had personalised their rooms with pictures and ornaments and those people spoken to were happy with their bedrooms and said that they were cleaned every day. Bedrooms are located on each of the floors, people can use a passenger lift to get to their room. There is a communal lounge on the first floor and a smaller lounge on the second floor. Each of these rooms had a small table to enable some people to eat their meal at a dining table. People are able to watch the television or listen to music in the lounge. The laundry is in the cellar and is accessed via steep stairs. The door to the laundry is bolted when the laundry is not in use, however the door is left unlocked when staff are working in the laundry. This presents a risk of accident if someone were to fall down the stairs. The laundry was clean and hygienic. All equipment in the laundry was in good working order. The manager confirmed that the hand wash basin had recently been removed as a new washing machine is to be fitted. The manager confirmed that a new hand wash basin is to be fitted in the near future. Laundry processes were discussed with a member of staff and it was noted that only people’s personal items are laundered. All bed linen and towels are laundered by an external laundry service. Soiled linen is put into a bag and taken to the laundry in a linen basket. The washing machine has the facility to sluice soiled laundry and wash at appropriate water temperatures. Disposable gloves and aprons are available in the laundry and other places around the Home. The laundry was clean and hygienic and there was no backlog of items waiting to be laundered. People spoken to said that the Home provides a very quick and efficient laundry service. Liquid soap and disposable hand towels are available in bathrooms and toilets. Thermometers are also available to monitor the temperature of bath water before people take a bath. There are three bathrooms, two assisted baths and a third bath which can be accessed by a hoist. Adaptations such as raised toilet seats and grab rails are available to meet people’s assessed needs. The Home has three hoists to assist those with mobility difficulties. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is good. There are sufficient numbers of competent staff on duty to meet the needs of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home was taken over by a new owner in January 2009. A new manager was appointed who has made some changes to the staffing levels. The number of staff on duty each day is as detailed below:8am – 1pm 1pm – 8.30pm 8.30pm – 8am 1 Registered Nurse and 5 or 6 care staff 1 Registered Nurse and 3 care staff 1 Registered Nurse and 1 care staff Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 23 Duty rotas confirmed that appropriate numbers of staff are on duty each day. Our survey asked people if staff are available when they need them. Five people said that staff are usually available, one said always available and one person did not answer this question. All people spoken to during the inspection were complimentary about staff saying that they were helpful, friendly and caring. One person said “the staff call in to your room so often during the day that you don’t ever need to use your call bell”, “staff are all friendly and helpful” another person said “staff are friendly, they come quickly when they are called and some staff have a really nice sense of humour”. The home has a low staff turnover and most of the staff have been in post for a number of years. The staff provide cover for absent colleagues and agency staff are not used. The manager has recruited care staff to enable staffing levels to be increased. The manager confirmed that she undertakes management duties a majority of the time but does like to work as a member of the nursing staff for fourteen hours per week. Senior nursing staff also have some time allocated to enable them to complete some administration duties. The annual quality assurance assessment completed by the Home records that seven of the thirteen care staff currently employed have achieved a National Vocational Qualification (NVQ) in Care at level two. One care staff has also achieved the NVQ in Care at level three and four staff are enrolled on this course, which should start shortly. This should mean that people living in the home are cared for by competent staff. The personnel files of three members of staff were reviewed. One file contained a reference which had been completed on the Home’s standardised documentation. The reference is addressed “to the manager” there was no address or record of who had completed the information or from what organisation. It was difficult to identify whether this reference is from an appropriate source. Each file contained a completed application form. Two of the files contained criminal records bureau checks (CRB) and one had a records check completed by a local police station. The manager confirmed that they are in the process of applying for CRBs and protection of vulnerable adults checks (POVA) for all new and existing staff to ensure that each person has appropriate employment checks in place to ensure that they are safe to work with vulnerable people. The training records in the three files reviewed contained limited information, one was blank, another file had a certificate regarding a wound care course and another a moving and handling course. A discussion took place regarding staff training. The manager confirmed that staff training records were not up to date. The records held in the staff files did not demonstrate that staff have attended recent mandatory training regarding first aid, adult protection and infection control. Records were seen to demonstrate that moving and handling and fire safety training has been undertaken recently. There were no other records to evidence what training has been undertaken. The manager said that she has developed new training records to show training undertaken since the new owner purchased the Home and these are being completed. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 24 Staff spoken to during the inspection said that the new owner has told them that he is in the process of “sorting out and arranging training needed”. They also mentioned training recently undertaken such as moving and handling and fire safety. A discussion took place regarding staff induction and training. The new owner has introduced induction training in line with the requirements of the Common Induction Standards. A blank induction record was seen. It was noted that newly employed staff are undertaking this training currently. These records were not available for review as staff are undertaking their induction currently and have their records with them. An in-house induction also takes place, this includes shadowing staff, review of policies and procedures and a tour of the Home. One member of staff who has been employed at the Home for three months confirmed that she undertook induction for the first two weeks of her employment. This included giving copies of policies and procedures to read, and shadowing another member of staff for two weeks. This staff member has already undertaken an NVQ in Care at level three and therefore would not need to undertake common induction standards. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33 and 38 were assessed. Quality in this outcome area is good. The home is well managed and has systems in place to ensure that the safety and well being of the people who live in the Home, visitors and staff are promoted and protected This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new Registered Manager has been employed since the Home was taken over by a new owner in January 2009. The manager was already working at Victoria Nursing Home as a qualified Registered General Nurse but took up the post of Manager in March 2009. The three senior nursing sisters have worked in the home for in excess of 20 years. Staff were aware of lines of accountability within the Home and reported that they receive excellent support from the new manager. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 26 Quality assurance systems were discussed and it was noted that although the manager is aware of the importance of setting up quality assurance processes, no action has been taken yet due to other priorities within the Home. There were no quality assurance systems in place before the manager’s employment. It was noted that informal, non documented audits take place daily, these include room audits, review of working practice, medication audits, however there is no documentary evidence to demonstrate that this takes place. The manager confirmed that there have been no satisfaction surveys, no residents or relatives meetings or documented audits/reviews of working practices. It was noted throughout the discussions that the manager is aware of the action needed to implement quality assurance systems and said that she is happy to receive any suggestions to improve their service. We were told that the home does not hold residents money for safekeeping. All residents have a relative or advocate independent of the home to help them to manage their finances. When discussing supervision with staff it was noted that annual appraisals have taken place in the past but there is no formal supervision system. The manager agreed that currently formally documented supervision does not take place and there were no supervision records to review. It was noted that the Home are in the process of implementing appraisal systems. A selection of records were examined to see if the Home have adopted appropriate systems and practices regarding health and safety. Records seen were up to date and demonstrated that servicing and maintenance of systems and equipment is carried out. For example, the passenger lift was being serviced on the day of inspection; mattresses and nebulisers were serviced in July 2008. Water checks regarding legionella risk were undertaken in January and June 2009. The last Landlords Gas safety certificate issued was dated September 2008 and records show that fire-fighting equipment was last serviced in December 08 and April 09. There is a fire risk assessment in place but the manager does not feel that this is up to date and therefore needs amending. Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 27 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP7 Good Practice Recommendations Care plans should be developed for all areas of need and should be reviewed and updated to include current information regarding care needs and equipment in use. Documentary evidence should be available to demonstrate that residents or their representatives are involved in the care planning process. Records should be made available detailing food intake for people who are losing weight or assessed as at risk of malnutrition. These should be made in sufficient detail so as to determine that the diet is suitable to maintain the person’s wellbeing. A system should be implemented which ensures that prescriptions are checked prior to dispensing. Dispensed medications and MAR charts should also be checked DS0000073210.V376170.R01.S.doc Version 5.2 Page 29 2 OP7 3 OP8 4 OP9 Victoria Nursing Home against a copy of the original prescription. 5 6 OP9 OP12 Only those medications classified as controlled drugs should be stored in the controlled drugs cabinet. Arrangements should be made for each person living in the home to engage in meaningful and stimulating occupation that matches their ability and cultural preferences. This should ensure that people living in the home are stimulated and improve their quality of life. People should be given a choice of food at each mealtime. Documentary evidence should be available to demonstrate the choices available and choices made. Consideration should be given to infection control by ensuring that a hand wash sink is made available in the laundry as soon as possible. Staff personnel files should include information such as references, application forms, criminal records bureau and protection of vulnerable adults checks, details of work history as evidence that the Home operate robust recruitment practices and obtain sufficient preemployment information. Training records should be available which show dates of training for all staff and training due to ensure all staff are kept up-to-date with necessary training to support people who live in the home. Systems should be in place for the review of working practices (including staff supervision) and quality of service delivered to people. This should make sure that the home is run in the best interests of people living in the home. The provider should seek the advice from the Fire Service about developing a fire risk assessment to include minimising risk for residents who prefer to have their bedroom door left open. This should safeguard people living in the home. 7 OP15 8 OP26 9 OP29 10 OP30 11 OP33 12 OP38 Victoria Nursing Home DS0000073210.V376170.R01.S.doc Version 5.2 Page 30 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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