Care Home: Villa Maria

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What the care home does well Villa Maria is an older style home with very traditional nursing values. Residents are still referred to as patients and there is a hierarchy of nursing staff with a matron, sisters, staff nurses and carers. However, for those people who like this structure it provides a warm and homely environment with all of the staff providing an excellent standard of care. Residents are encouraged to see the home as being "their home" and both they and the staff, and this includes the cook and ancillary staff, consider themselves to be a part of the Villa Maria family". The presence of the dog and cats that wander freely round the home add to this feeling and everyone we spoke with told us how happy they were to live there and how wonderful matron and her staff were. The home works hard to put the wishes of residents at the centre of everything they do. Frequent consultations with them ensure that there are activities organised to suit them and that the food that they are served is in accordance with their preferences. The home benefits from having its own minibus so residents can be taken on trips and outings if they wish although increasingly more people are being admitted into the home who are quite frail. Recognising this, the home is providing training for staff such as hand massage so that they are able to spend time just interacting with very unwell people on an individual basis. Over the last year the home has continued to develop an expertise in the field of palliative care gaining Beacon Status in the Gold Standards Framework accreditation process. The home has established a reputation for providing care for people with very complex needs and requiring a high level of nursing expertise. What has improved since the last inspection? Since we last visited the home has completed the accreditation process of the Gold Standards Framework. This initiative has been created to provide the best possible care for those people who are nearing the end of their lives and their families. Villa Maria passed 16 of the required elements at the level of excellent, the highest number of accolades ever awarded to a nursing home in the UK in the history of the awards. Routine maintenance and an ongoing refurbishment and redecoration programme ensure that the home remains a pleasant place for people to live in. Rooms are redecorated before people move in and new furniture, beds and pressure relieving equipment have been purchased. More plants have been purchased for the garden, which is a feature if this home and new garden furniture has meant that more people are able to enjoy being outside in the warmer weather. Staff training continues to be given a high priority with staff undertaking courses in palliative care and dementia as well as those subjects considered to be mandatory such as moving and handling and fire safety. What the care home could do better: We did not make any requirements at this inspection, and we have not received any complaints about the service since our last visit. The Annual Quality Assurance Assessment that we received was very clear, gave us all of the information that we needed and told us about the plans that the home has to ensure that they continue to provide the best possible care and support to the people who are using their service. It is our judgement that the home still provides excellent quality outcomes for the people who live there and we will continue to inspect according to our current guidelines. Key inspection report Care homes for older people Name: Address: Villa Maria Villa Maria Nursing Home 62-68 Croham Road South Croydon Surrey CR2 7BB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Ford     Date: 0 3 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Villa Maria Villa Maria Nursing Home 62-68 Croham Road South Croydon Surrey CR2 7BB 02086801777 02086807001 villa@villamaria.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Linda Dianne Thompson,Miss Jean Margaret Hedgeland care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category terminally ill Additional conditions: A maximum of five service users in the TI and TI(E) categories aged 40 or over. A variation has been granted to allow day care to be provided for one specified service user. A variation has been granted to allow one specified service user in the category of Learning Disability - over 65 years of age (LD(E)) to be accommodated. Date of last inspection Brief description of the care home Villa Maria is a traditional nursing home, founded in 1974, and registered for 26 older people. It is situated close to the centre of Croydon and is easily accessible by public transport. Accommodation is arranged over two floors and there is a passenger lift. There are both single and double rooms, some with en-suite facilities. All the communal rooms overlook large, well-maintained and very attractive gardens, which Care Homes for Older People Page 4 of 27 Over 65 26 0 0 26 Brief description of the care home are well used in the summer months. The home benefits from having its own ambulance. Service users can enjoy the benefit of this being a pet-friendly home. The fees at the time of this inspection range from £650 - £900 per week and would be agreed prior to admission. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report follows an unannounced visit to the service. However, when writing the report we have also taken into consideration other information that we have received or asked for since our last inspection in January 2007. This has included information about how the service has managed any complaints, things that they have told us about what has happened there, notifications, and what other people have told us about the home. In addition the home has sent us their Annual Quality Assurance Assessment ( AQAA). This is a self assessment of how well they believe they are fulfilling their aims and objectives and meeting the needs of those people who use their service, and also about their plans for the future. When we visited, we spent time walking round the home and talking with the staff and residents. We also looked at various records and documentation that the home is required to keep as evidence of its commitment to the health and safety of those who live and work there. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: We did not make any requirements at this inspection, and we have not received any complaints about the service since our last visit. The Annual Quality Assurance Assessment that we received was very clear, gave us all of the information that we needed and told us about the plans that the home has to ensure that they continue to provide the best possible care and support to the people who are using their service. Care Homes for Older People Page 8 of 27 It is our judgement that the home still provides excellent quality outcomes for the people who live there and we will continue to inspect according to our current guidelines. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 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. No one is admitted in to the home without a full assessment of their needs being undertaken so that the home can be sure that they can be met and the resident feels that they will be happy living there. The home does not offer intermediate care this standard does not apply. Evidence: Anyone considering coming to live in the home, or referred through care management arrangements or the Primary Care Trust would be invited to visit with their relatives to see if they liked it. If, as is often the case, they were too frail or unwell the Head of Care would visit them, to undertake an assessment of their needs. This involves looking at all aspects of how care will be delivered. For those who are funded via the local authority or PCT there would also be an assessment and a care plan from them. In addition there is a three month settling in time with a review at the end. This helps to minimise the risk of any unsuitable placements. Care Homes for Older People Page 11 of 27 Evidence: Potential residents are given written information such as The Service User Guide which tells them all about the home and the way that it is run. The home aims to provide a very homely atmosphere and the ethos is one of coming to live in the Villa Maria Family. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health care needs are being met in a way which meets their needs.Policies regarding the storage and administration of medication are in place to protect them and they are treated with dignity and respect. The home has developed an exceptionally high standard of expertise in caring for those at the end of their lives. Evidence: The home uses a person centred approach to care planning in which residents, with their families are helped to make decisions about the care that they need and how they wish to be supported. The care plans that we looked at showed that residents health, personal care and social needs are all adequately covered and there is access to community services where appropriate. Risk assessments and care plans are in place for people who may be at risk of developing pressure sores and there is appropriate pressure relieving equipment in place wherever necessary. There are also nutritional risk assessments in place and Care Homes for Older People Page 13 of 27 Evidence: guidelines to help minimise the risk of any falls. We were able to see photographic evidence which showed that some residents had been admitted with quite extensive pressure sores and that these had been treated so that their wounds were greatly improved or healed. The home operates by The Gold Standard Framework, delivering the best possible care to people who may be nearing the end of their lives and since the last inspection they have been awarded Beacon Status denoting their excellence in this area. The home gained the highest score ever in the country passing 16 of the required standards at excellent. When residents are admitted they encouraged to discuss their end of life care and to think about any advance directives. This might include any particular wishes that they have, or things that they have always wanted to do. The home would discuss with them how these might be achieved. Several helpful leaflets have also been developed which help to give them and their families useful information about concerns that they might have at this time. People who have died in the home are remembered at an annual service. We were able to see the book of remembrance which is being compiled with a photograph of each of them and a special poem chosen as a tribute. There is also a memorial garden and we were told that relatives often return to sit their and remember their loved ones. When we visited many of the residents were in the lounge, although they are able to stay in their rooms if they wish. All of them looked clean and well cared for, they had been helped to choose appropriate clothing and ladies who wanted to had been helped to apply their make up. Several of them were very happy to speak with us and they were unanimous in their praise of the staff and the way that they were cared for. No one raised any concerns about how their privacy was respected, they told us that staff were kind, very caring and that this is a wonderful place to live in, I am very lucky. Those people that were being nursed in bed, because they were unwell, looked clean and comfortable. Since the last inspection the way that medication is ordered and administered has changed to a monitored dosage system. It is closely monitored and audited and no errors were noted. Care Homes for Older People Page 14 of 27 Evidence: It continues to be particularly notable in this home that there is a clear aim among all grades of staff, including catering and ancillary staff, to provide care to the best possible standard that they can. There is a feeling that residents are loved as well as cared for and that they are considered to be a part of The Villa Maria Family. Care Homes for Older People Page 15 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. The lifestyle in the home meets the expectations and preferences of the people who live there. There are activities and outings for them to join in with if they wish, their friends and families are always welcome to visit and they enjoy the food that is served to them. Evidence: Residents meetings are held regularly and these give people the opportunity to discuss activities and outings that they would like and menu ideas. The home benefits from having its own minibus and there are regular outings and shopping trips. Residents are also able to register with Dial-a Ride or use computer cabs. Children from local schools come in to the home and entertain the residents and outside entertainers are arranged. We were able to see photographs of some of the outings that have been enjoyed including a trip to paddle in the swimming pool of one of the homes proprietors. The home also encourages outdoor activities such as walking round the well maintained garden or playing ball with the dog. Two of the staff now undertake recreational activities one afternoon a week and on the day that we visited they were all making decorations and cards for Christmas. Other decorations that they had made were hanging up in the lounge. It is recognised Care Homes for Older People Page 16 of 27 Evidence: that the homes expertise in providing palliative care has meant that many of the residents are too frail to take part in organised activities and some of the staff have been taught to give hand massages, understanding the importance of giving individual time and attention to people. The home is animal friendly and has recognition from the Cinnamon Trust, a charity which promotes the relationships between the elderly and their pets. Currently residents enjoy the company of Toby, a young border collie terrier cross and two cats, Fluffy and Boo. The animals wander around the home and bring a great deal of happiness to residents who spoil them all with treats. The relatives of residents who have had to leave pets at home are also able to bring them in when they visit. People told us that the food in the home is very good. The emphasis is on traditional British dishes however, other preferences and dietary needs can always be catered for. We are told that some of the homes ethnic staff have helped by providing the cook with authentic recipes. The work that has been undertaken for the Gold Standards Framework has also included the cook being able to understand how peoples nutritional needs change when the become unwell. We saw that there is an attractive, well appointed, dining room where meals are served and that tables are nicely set out with tablecloths, place mats, fresh flowers and table decorations. Friends and relatives are always welcome to visit, those who are on their own will be invited to join residents for Christmas lunch. Visitors can be received in the lounge or in private areas and each bedroom has a telephone for residents to use. Care Homes for Older People Page 17 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. Their are satisfactory arrangements in place to address any concerns that are raised and residents can be confident that this will undertaken appropriately. Evidence: The home has a clear complaints procedure in place and residents are advised of the process in the Service User Guide given to them at the time of admission. Neither the home, nor The Commission, have received any complaints about the service since the last inspection. No new member of staff is appointed without all of the necessary checks being undertaken so that residents are protected from those judged as being unsuitable to be working with vulnerable people. All staff have received training in recognising and reporting suspected adult abuse. Care Homes for Older People Page 18 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. The home is well maintained and suits the needs of the people who live there. Evidence: This is a relatively small nursing home which helps to create the homely atmosphere. It is well maintained, in a style which suits the people who live there. Residents bedrooms are comfortably furnished and are decorated for them prior to admission. They have been encouraged to personalise them with pictures, photographs and small items of furniture. There is ample communal space and a large lounge looks out over the beautifully maintained garden, a feature of this home. There is also a separate dining room. All areas of the home are accessible to residents and adaptations such as hand rails and ramps help those with limited mobility. There are sufficient numbers of toilet and bathing facilities and residents can choose either to bath or shower. A nurse call system is in place throughout the home. On the day that we visited, the Christmas decorations had just been put up. The home was looking very festive with hanging decorations, animated Santas and items that the residents had made in their craft sessions. The prescence of the dog, Toby, and the two cats add to the overall feeling that this is seen as the home of the people who live here and not just a nursing home. As always, the home was completely free from malodour. All staff have been trained Care Homes for Older People Page 19 of 27 Evidence: in the prevention of cross-infection and have access to appropriate equipment such as gloves and aprons. Care Homes for Older People Page 20 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. There are always enough suitably trained and experienced staff on duty in the home to meet the needs of the people who live there. Evidence: Staff turnover in the home is very low and careful consideration is always given to the appointment of new staff to ensure that they will fit in to the Villa Maria family ethos. Given the high proportion of residents needing palliative care it is particularly important that staff have an interest in supporting these people and their families. We previously saw that no new staff members were appointed without all of the necessary checks being undertaken and since that time only one new person has come to work in the home. The home is always staffed by both trained nurses and care staff in sufficient numbers to meet the needs of the residents and they are supported by domestic and ancillary staff. Staff training is given a high priority in the home. We saw that they have undertaken training that we consider to be mandatory, such as moving and handling, health and safety and fire training, and also training specific to residents needs such as dementia awareness and palliative care. Care Homes for Older People Page 21 of 27 Evidence: Over 97 of care staff, above the minimum standard, have attained an NV level 2 award and any new staff member would have a comprehensive induction programme to ensure that they were competent and confident to support resident in the way that they prefer. All of the care staff receive regular supervision to help monitor their work and identify any future training needs and there is a yearly staff appraisal system in place. Care Homes for Older People Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well manged by a person who is fit to be in charge and in the interests of the people who live there. Evidence: The home has been managed by Mrs Maureen Donnelly for some years. She has an NVQ level 4 as well as qualifications and a high level of expertise in palliative care. She speaks frequently about the skills of my team and all of the staff are obviously very valued for their contribution to the care they give people. The homes providers are also frequently there and can ensure that the home is meeting its require aims and objectives. When we looked at some of the examples of staff supervision we were able to see that they have been encouraged to consider to consider what they have learnt from caring for people who were at the end of their lives. Their responses illustrated how much staff consider themselves to be a part of the Villa Maria family. Care Homes for Older People Page 23 of 27 Evidence: Staff work with the residents and try to make their wishes central what they do. There are regular quality assurance surveys sent out about the services offered by the home including following a bereavement to see if people think any improvements could be made. Policies and procedures in the home are reviewed regularly and we are always notified of anything that happens there relating to the health and safety of people who use the service. The home does not look after the finances of any of the residents in the home. The information that we have been given tells us that all of the equipment and services in use have been appropriately maintained. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 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 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 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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