Inspection on 17/11/09 for Chaplin Lodge

This is the latest available inspection report for this service, carried out on 17th November 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chaplin Lodge 14/05/07

Chaplin Lodge 22/05/06

Chaplin Lodge 07/02/06

Chaplin Lodge 09/09/05

Chaplin Lodge 08/02/05

Chaplin Lodge 24/06/04

Chaplin Lodge 04/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Chaplin Lodge Nevendon Road Wickford Essex SS12 0QH     The quality rating for this care home is:   one star adequate 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: Sharon Lacey     Date: 1 7 1 1 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 35 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 35 Information about the care home Name of care home: Address: Chaplin Lodge Nevendon Road Wickford Essex SS12 0QH 01268733699 01268570602 chaplinlodge@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 66 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE Date of last inspection Brief description of the care home Chaplin Lodge is a care home which provides personal care without nursing for up to a maximum of sixty-six older people. They are registered to provide care for up to a maximum of eighteen people who have a diagnosis of dementia. Accommodation is provided in the main area of the house over two floors, which is accessed via a passenger lift. Residents have access to a number of communal areas including lounge and dining rooms. The home is situated in a busy residential area close to Wickford Care Homes for Older People Page 4 of 35 Over 65 0 66 66 0 Brief description of the care home town centre. The cost of a place at the home is £453.11 to £595.oo per week, depending on accommodation and dependency needs. Care Homes for Older People Page 5 of 35 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: one star adequate 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: The Last Key Inspection to Chaplin Lodge took place on the 7th May 2008 and an Annual Service Review took place on 5th May 2009. Due to the findings of the Annual Service Review a further Key Inspection was arranged for the 17th November 2009. The Key inspection was in the form of an unannounced inspection and took place over two days. A second day was arranged to speak with staff and residents. All the Key Standards were inspected, but also evidence was gained on some of the other National Minimum Standards. A tour of Chaplin Lodge was completed and an inspection of relevant records and documentation took place. Areas looked at included information given to residents before being admitted, information gained when residents first come into the home, how information is given to staff on the care residents may require, the facilities and the environment of the home, and any complaints or safeguarding issues that may Care Homes for Older People Page 6 of 35 have been received since the last inspection. Also staffing and management of the home were inspected. An Annual Quality Assurance Assessment (AQAA) was sent to us by the Manager. The AQAA is a self-assessment in which services identify how they feel outcomes are being met for the people using the service. The AQAA submitted provided information on how the service had improved over the last 12 months and what improvements they still hoped to make. Information from this document has also been used in this report where appropriate. During a tour of the home a number of residents were spoken with about their life experiences at Chaplin Lodge. Some of the residents approached were unable to express their thoughts or feelings, so they were observed during the day interacting with staff and visitors. Questionnaires were sent out to residents, relatives, and also healthcare professionals. Information from those returned have been included in this report. Most staff members on duty were spoken with informally during the visits to the home and any feedback has been included as part of the report. Staff questionnaires were also distributed and information from those returned have been included. At the end of the day the findings of the inspection on the home were discussed with the Manager and advice and guidance was given. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: At the last Inspection is was highlighted that some areas around the home were beginning to look tired and in need of redecoration. At this inspection very little had been done to the environment of the home and some areas had deteriorated further. The home was also dirty in some places and the ceilings had cob webs. This is an area that needs urgent attention as the home is deteriorating and residents do not live in a home that is well maintained. The area around complaints and safeguarding needs to be tightened up. Since the last inspection there have been issues/complaints raised that do not appear to have been fully investigated and a written record kept. Staff spoken with raised concerns over the staffing levels at the home. They stated Care Homes for Older People Page 8 of 35 that at times there were often only two staff on the Units, instead of the rostered three. They provided examples of how this could restrict residents choice and also residents safety. Staffing levels need to be sufficient to meet the changing needs of the residents and respect peoples preferences and provide individual care. 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 35 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 35 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. Prospective residents receive sufficient information to enable them to make a choice on whether Chaplin Lodge is able to meet their care needs. They can also be confident that their care needs will be catered for as a full needs assessment will be undertaken prior to being admitted. Evidence: The AQAA submitted confirmed that brochures are sent out to prospective residents. A copy of the Service Users Guide and Statement of Purpose could be found in the Homes foyer. The Manager stated that both documents had been updated. On viewing these the information was found to be correct, but there was no review date. The Manager confirmed that new and prospective residents would be given copies of the Service Users Guide during the assessment process, but this is not at present routinely recorded. Both documents are also available on audio cassette. One staff member fed back on their questionnaire the information provided to potential service users is good. Care Homes for Older People Page 11 of 35 Evidence: Details of the admission process could be found in the Service User Guide and Statement of Purpose. The Manager confirmed that all new residents would be visited before being admitted, to help ensure that their care needs can be met. She added that a letter would also be sent out to perspective residents to confirm whether Chaplin Lodge would be able to meet the prospective residents needs. Files viewed contained a copy of this letter. The home has a pre-assessment form and all three residents files viewed contained a full assessment. The assessment form consisted of tick boxes, which highlighted dependency levels and covered all areas listed in standard three of the National Minimum Standards. The Manager had also recently introduced a Life History Book, which contained information about the individual resident during different stages of their life. On viewing this document it was felt that this would assist the activities coordinator when planning activities, as they would be aware of the individuals previous hobbies and interests. The Manager advised that private residents would be given a contract as soon as they are admitted into Chaplin Lodge, but those who were under Social Services care would receive their contract after their six week review. Two files were viewed and both contained a contract, which had details of the room number, the costs and had also been signed by the resident or relative. Chaplin Lodge offer perspective residents trial visits. The Manager stated that all new residents are encouraged to spend a day at the home and it was noted that the Statement of Purpose contained details about this. The AQAA stated that one area they would like to improve is in connection to introducing a guest day for prospective residents and to try arrange for local authorities to fund this. Also, they would like to allocate key workers to residents before they come into the home, to enable them to identify a named staff member and make them feel more welcome. The staff at Chaplin Lodge had attended lots of training since the last inspection. A copy of the training matrix was provided and this showed staff were up to date with training and had the knowledge and experience to care for their present residents. Also, at least 31 staff had attended dementia training since the last inspection. It was noted that the certificate of registration in the Homes Foyer was incorrect and had not been updated. This was brought to the Managers attention. Intermediate care is not provided at his home. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that medication practices at the home will keep them safe and they will receive the care they need. Evidence: Three residents files were viewed and all contained a care plan, which had been completed around the care needs of the individual and included details on how the care was to be provided. Those care plans seen had been reviewed at least monthly and updated to reflect any changes of care. When staff were asked if they were given up to date information about the needs of the people they support or care for, one said always, two said usually and two said sometimes. All three files contained documentation to indicate that the residents are supported and have access to a variety of health care resources (GP, District Nurses, hospital visits etc). Two District Nurses were visiting on the day of the inspection and there was good interaction between them and the staff and they were observed working well together. The Manager advised that the old managers office had been made into a treatment room, to enable residents to have their treatment from health care professionals with privacy and respect. Care Homes for Older People Page 13 of 35 Evidence: There was evidence of weight records on the service users files and the residents had access to scales. Visits to dentists and opticians are arranged as needed and files contained documentation to support this. Files contained a record sheet, which recorded visits from other professionals. There were also daily record sheets, which had good records of care provided and other relevant information. Two residents presently have pressure sores. When walking around the home it was noted that there was some fairly dependent and frail residents at Chaplin Lodge, who were being cared for in bed and these had airflow mattresses to assist with their pressure care. Also, when looking at the training matrix it showed that all staff had received pressure care training, which was something that had been highlighted in the last Key Inspection. The home has a policy on the Administration of Medicines, but this was not viewed during this inspection. It stated in the Service User Guide that residents can take responsibility for their own medication, but staff advised that most choose to have assistance. Medication at the home is managed through a monitored dosage system (blister packs) and is appropriately stored. It was confirmed by a staff member that Boots the Chemist provide medication training to the staff at Chaplin Lodge. The medication folder contained copies of signatures of staff who assist with medication and photos of the residents to assist with identification and any medication audits. A sample of medication forms were viewed and these were found to be correct and had no anomalies. There was a separate refrigerator to enable them to store medication at the required temperature. Staff had access to liquid soap and paper towels to assist with infection control. Medication boxes had been dated when they had been opened. The Manager stated that monthly audits are completed on medication and documentation was seen to support this. The staff member spoken with confirmed that some residents require controlled drugs and that these are stored appropriately. On looking at the controlled drug medication record, it showed that on one occasion two staff members had signed for a controlled drug, but then found that the person was not present in the home, so this had been crossed out, but no record made on the reason why. The correct process was discussed with the staff member during the inspection . Privacy and dignity was found to be covered in the Statement of Purpose and Service User Guide. On observing staff it was found that they generally respected the residents and ensured toilet doors were closed and care was provided appropriately. On speaking to one residents relative regarding the care provided at Chaplin Lodge, it was stated that the clothes that the resident had on were not his own and this Care Homes for Older People Page 14 of 35 Evidence: included his trousers, his jumper and his vest. They also pointed out that although he was registered with one name, he had always been known as another, but the staff insisted on calling him the one he was registered with - even though the relative had pointed it out to staff. When asking how long the resident had been at the home they had been there for three years. When speaking to this relative it was also noted that the residents nails were dirty. The Manager confirmed that they try to ensure residents are able to stay at home in familiar surroundings for as long as the staff are able to provide appropriate care. There is a policy and procedure on the care of the dying and is also part of individual residents care plans. As previously stated there were a number of residents who were very frail and the Manager stated that they would continue living at home for as long as they are able to meet their needs. Care Homes for Older People Page 15 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be given the opportunity to take part in a variety of activities, both as an individual and also as a group. Evidence: The AQAA reported that residents interests and needs are considered whilst they are encouraged to take part in meaningful activities. Chaplin Lodge have two activity Coordinators who work with the residents and there is an activity programme, which includes manicures, bingo, music and dance, movie magic, piano, puzzles, one to ones, hobby time, flower arranging, out and about, gentle exercise, reminiscence and craft. On the day of the inspection there was very loud music being played in the dining room, but there was very little activity provided for the residents in the downstairs lounge. In the afternoon the PAT dog came to visit the residents on all of the units. The Manager stated she had recently arranged for a small zoo to come in, which the residents really enjoyed. They had also changed a bedroom on one of the units into an activity room. On speaking to one relative she stated that the activities were quite good and they had joined in some of the evening entertainment that the Manager had arranged. The AQAA reported that the home has developed a relationship with a local pre-school/primary school group, which included a trip to see the Christmas Nativity and visits from the children to the home. The AQAA added that Care Homes for Older People Page 16 of 35 Evidence: they plan to introduce more visual and memory aids around the home. There is an open visiting policy at Chaplin Lodge and it was noted that relatives and visitors called in during the day. There is no specific visitors room available, but whilst touring the home it was clear that there were quiet areas that could be used. One set of visitors used the dining room. The Manager stated that they encourage families to visit and be part of any entertainment. She also advised that familys are welcome to take meals with the relatives. Individual bedtimes had been recorded, which showed that some residents had had an active role in choosing the time they wanted to go to bed and what care was to be provided. It also stated in the Service User Guide that meals could be provided in residents rooms, and on the day of the inspection residents were observed sitting in the lounges eating their meals. It was noted whilst looking at care plans that residents had been consulted over their care to include choice were possible. On speaking to staff it was established that due to staff shortages this was not always happening and this process needs to be improved and developed by ensuring sufficient staff are on duty to provide the care recorded and required. The Service User Guide stated that breakfast is served from 7.00 am, morning drinks 11.00 am, lunch 1.00 pm, afternoon drink 3.00 pm, supper 5:30 pm and evening drinks at 7:30 pm. New menus were being introduced, which included colourful pictures and words on what was on offer each day. On the day of the inspection there were no menus on the table or details on any of the noticeboards on what was going to be served for the day. Those residents spoken with did not know what was for dinner, but did confirm that they were offered a choice of meals each day. One relative raised concerns that the last snack is served at 7.00 pm and many residents do not have their breakfast until at least 8.00 am the next morning. This would give an average of 12 hours without any food or drink. They added that this caused her some concern as her relative was diabetic. It also raised concerns for those residents who were unable to request food and drink if they were hungry. This was brought to the Managers attention. Dining tables were noted to have napkins, glasses, table mats, and tablecloths, which provided pleasant surroundings during meal times. Residents were served juice with their meals. Tables had salt and pepper and also vinegar, but it was noted that no sauces had been provided. Whilst touring the home during lunchtime it appeared that some residents had been offered gravy whilst some had not. Choices available on the day of the inspection for dinner was cottage pie or fishcakes Care Homes for Older People Page 17 of 35 Evidence: and lemon Meringue or rice. From observation it was seen that the meal was served hot and well presented. One staff member went round to each of the residents to see if they would like seconds of vegetables or meat. One gentleman spoken with stated it is not too bad, another stated its nice, food very good - cant eat it all - far too much and its all nice. Those residents who needed assistance with feeding had this done with time and respect. Staff spoken with said the time allocated for assisting residents with their food would depend on the number of staff allocated to each unit. The AQAA reported that management want to consider ways of making meal times fun, appropriate, enjoyable and efficient, but did not provide any further details. Documentation seen provided details of residents nutritional records and included the date, what the resident had eaten and also the quantity. There were nutritional risk assessments in place for those residents who required them. The kitchen was inspected and noted to be clean and tidy. There was a good supply of food and fresh fruit and vegetables. A complaint had been made to the CQC regarding the kitchen cupboards being locked at night and staff not being able to gain access to food for residents if needed. This issue was discussed with the Cook and it would appear that food stocks have been going missing at night and due to this management have had to put procedures in place to ensure the fridges and cupboards are now locked. To ensure that residents are able to gain access to food and drink outside of the Cooks working hours, they have arranged for a supply of essential stores to be made available and stored on each unit. Care Homes for Older People Page 18 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and relatives will have access to a complaints procedure to enable them to raise concerns or issues, but they cannot be fully confident that their concerns will be acted upon. Evidence: The AQAA reported that for formal complaints received in the home, a letter of acknowledgment is sent out informing the complainant of what will happen in the investigation and timescales. There was clear written guidance in the Service User Guide, but it was noted that this contained the address of the Cambridge CQC office, which is now closed. The complaints procedure provided details on how to make a complaint, the investigation process and also any time spans. The complaint folder contained a complaint form with space to write details of the investigation and outcome. On viewing the forms it was apparent that complaints from individuals had not always been fully recorded and records were incomplete and did not include details of outcomes or any action taken. Some had copies of letters received and also a response to the complainant, but the complaints form had not been fully completed. On viewing two complaints forms it was noticed that both raised safeguarding issues around care provided to residents by the staff, but neither had any details of the investigation or outcome. When discussing these complaints with the Manager she advised that one had been referred to the safeguarding team, but the other was before she became Manager at the home, so she was not aware of any action that had been taken. The CQC had also received a complaint from a relative whose mother had Care Homes for Older People Page 19 of 35 Evidence: stayed at the home and had raised a number of concerns. It became apparent that it was not possible to investigate this complaint due to it not being brought to the Managers attention at the time. The recording of complaints is an area that needs to be tightened up to ensure they are thoroughly investigated, recorded and where required appropriate safeguarding referrals made. The AQAA reported that an aim for improvement over the next 12 months is to ensure that any issues regarding adult protection are dealt with in line with local and regulatory policy and all actions are fully implemented within the home. There was a copy of the No Secrets document in the foyer. The Manager confirmed that all staff had attended safeguarding training and documentation seen supported this. The Manager has yet to attend. Care Homes for Older People Page 20 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be provided with a physical environment that is appropriate to their specific needs, but does not offer them a clean, safe and homely place to live. Evidence: The Manager stated that some decoration had been done since the last inspection and the AQAA reported the home is undergoing continual decoration and improvement, it continued simple tasks of auditing the Homes environment are in place and are available to any one who wishes or requires to see them. These give evidence of the maintenance of high levels of hygiene control within the home. A requirement was made at the last inspection with regards to the premises and garden being kept in a good state of repair. A tour of the premises was undertaken during this inspection. The layout of the home is suitable for the residents needs and is generally comfortable, but the decoration and carpets are looking tired and worn. It was noted the door to the administrators office was broken and was in need of repair, the Manager stated this had been like that for a couple of weeks. The wallpaper in the foyer was noted to be torn and faded in some places, some decoration had been done in the foyer and around the home, but this consisted of mainly painting over the old wallpaper. It was noted whilst touring the home that many of the door frames and skirting boards around the home were chipped and dirty. A crack in the wall upstairs, which was pointed out at the last Care Homes for Older People Page 21 of 35 Evidence: inspection 18 months ago was still there and no maintenance had been done. There was also plaster coming off the walls in the same area. A tap in one of the rooms did not have much pressure, this was pointed out to the maintenance man who arranged for a plumber to call. The chairs in the downstairs lounge were in fairly good condition and so was the furniture in the dining area. The kitchen in the dementia unit was worn and in need of replacement, but the broken kitchen cupboard had now been mended . The premises had not been kept clean, hygienic or free from offensive odours. There were cobwebs in the upstairs toilet and shower room. There was a dirty sink in the toilet by the laundry. In a downstairs toilet there were cobwebs on the ceiling. There was dirt under the stairs by the kitchen, but the Manager had arranged for this to be cleaned before the inspection was completed. In the staffroom it was noted that the carpet was dirty, the walls were dirty, there had been a leak down one wall, it had no sink facilities for staff and there was very little information to staff on the noticeboards. At 12 oclock it was found that in one room the floor was still dirty and the windows were smudged and difficult to see out on to the court yard garden. When entering the downstairs toilets (which had no outside ventilation), it was noted that neither of the extractor fans worked and one had a foul odour. The Manager was not able to say how long these had not been working. It was noted that the lino in the toilets downstairs near the managers office was coming away from the wall and it was stained and smelt of urine. Another toilet on one of the units was out of use due to the floor being dangerous. Many of the carpets throughout the home were also tired and in need of replacement or heavy cleaning. Staff spoken with raised concerns about the condition of the home with one adding relatives are raising concerns. One also added that due to the decoration and environment of the home that it was not easy to do a good job. One complaint the Manager had received from a relative whos mother stayed at the home was with regard to the bottom sheet not being changed for 4 weeks, only one pillow on bed and the mattress being stained. The Manager stated that she had recently been asked what decorating need to be done at home, but the inspector stated that it was very disappointing that very little has been done since the last inspection and that there were areas of the home that were now also dirty as well as requiring decoration. There are no shared bedrooms at Chaplin Lodge. Some of the resident bedrooms had been nicely decorated and were personalised with ornaments and photographs and had very nice bedding. In other bedrooms it was found that they were in need of decorating and the bedding was of a poor quality and was very thin. It was felt that some other rooms could be more personalised and bedding could be a better quality. Radiators throughout the home had been covered and there were sufficient lighting. Care Homes for Older People Page 22 of 35 Evidence: The water temperatures checked in residents bedrooms were found to be hand hot and had regulators fitted. There were suitable bathrooms and toilets around the home, which are situated in appropriate places for the residents to gain access to. During a tour of the home it was noted that there were sufficient hoists, wheelchairs, airflow mattresses and that residents used a variety of walking aids to assist with their mobility. At the last inspection it was requirement that suitable arrangements were in place for infection control and this included staff training. It was noted that hand sanitiser was in the foyer for visitors to use and there was soap and disposable towels in the toilets and bathrooms. When looking at the training matrix it was confirmed all staff had completed infection control training. When visiting the laundry it was found that there were two washing machines and one drier. On discussion with the staff member it became apparent that one of the washing machines was not working and this had been like this for a number of months. The home presently has at least 57 residents, many of which are incontinent of urine and it was felt that one washing machine was not sufficient to meet the laundry needs of the residents. Each resident had a basket with their name and they are presently looking to add photographs of residents to help staff with identification. There was only one door going into the laundry, which meant that dirty and clean laundry was mixed at one end, which could have infection control issues. Care Homes for Older People Page 23 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents may not have their care needs met due to there not always being sufficient staff. Evidence: The Manager provided staffing rotas for the last three weeks and these contained the required information. The AQAA added that the forward planning of rotas has developed and staff are utilised within their duties according to appropriate levels of skill mix. The present staffing ratio consists of one staff member to eight residents during the day and one staff member to ten residents at night. There are three units within the home and each are rostered to have three care staff in the morning and afternoon. Staff presently work 12 hour shifts and when discussing these with staff they were very positive and stated they found these better as they only worked approximately 3 days a week. The Manager stated that with staff working 12 hour shifts this also helped with continuity as many were willing to work an extra day to cover annual leave and sickness. Staff spoken with raised concerns over the staffing levels at the home. They stated that at times there were often only two staff on the Units, instead of the rostered three. They provided examples of how this could restrict residents choice and also residents safety. This included waiting to go to the toilet, needing to wait to require assistance with feeding (one staff member gave an example where a resident did not Care Homes for Older People Page 24 of 35 Evidence: receive their meal until 15:00pm), breakfast not being served until 9.45am, starting medication late (which had an implication on the lunch time medication) and some residents needing two staff to assist with their personal care, which then left the unit lounges without any staff present - which could have health and safety implications. The present staffing levels of Chaplin Lodge were discussed with the Manager and she was advised that the number of staff would need to reflect the dependency levels of the present residents and whether the staff are able to meet their care needs, not the number of residents at the home. Management and staff need to ensure they provide a service to residents that is individual, flexible, person centered and meets the residents needs. They need to ensure they are able to meet the changing needs of the residents and respect peoples preferences and provide individual care. When staff were asked if they were given enough time to meet the assessed needs of the residents four stated sometimes and one said never. One staff member also added there is not much time to sit down and talk to the residents any more because there is so much work to do (paperwork) and due to lack of staff, The Manager confirmed that there was a three day in-house induction and documentation was seen to support this. It was confirmed that the Skills for Care induction is completed if the new staff member had not already achieved their NVQ 2. Feedback from the staff questionnaires was very positive and three stated their induction covered everything they needed to know very well, whilst two said it mostly did. There is a recruitment policy and procedure and it is the Managers responsibility to ensure that all the information required is gained before the new staff member starts work within the home. At the last inspection a requirement was made with regards to ensuring that a full employment history is gained at the recruitment stage and that any gaps are discussed and recorded. The Manager and Administrator had been going through staff files to ensure that all the information required was present. The files seen were well set out and the information was easy to find. The files of two new staff files were viewed, it was noted that there was a personal profile checklist at the front of each file to record what information had been received back. Each staff member had completed a health declaration, a criminal record declaration, Criminal Record Check and an application. It was noted that on one file there were gaps in the employment history and no reason for these had been recorded, but generally the files contained all the required information. At the last Inspection a requirement was made with regard to the training of staff. Care Homes for Older People Page 25 of 35 Evidence: Training required included moving and handling, safeguarding and infection control. Since the Manager has been in post she has arranged a training matrix and this clearly showed what training staff had completed and the date it was done. Training organised since the last inspection included fire safety, fire drills, food hygiene, moving and handling, COSHH, health and safety, abuse and protection of vulnerable adults, infection control, nutrition, safe handling of medication, pressure care, customer care, care planning, challenging behaviour, dementia and first aid. There were a couple of staff who needed updates on moving and handling, but generally staff are well trained. Other training the Manager stated had been organised including NVQ 2 at Chelmsford College, Skills for Life and activities training. Training is provided at Chaplin Lodge and also at other care homes. The Manager advised that the deputy had completed training on nutrition and dementia and this is cascaded down to staff. Sixteen staff have now achieved their NVQ 2, three staff have NVQ 3 and the Manager has her NVQ 4. It was confirmed that a further four were doing their NVQ 2. This means that the home has nearly achieved the 50 ratio. Care Homes for Older People Page 26 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and others will be consulted with to gain their views on the quality of service provided by staff and management, so improvements can be made. Regular safety checks are completed to ensure there is a safe environment for residents and staff. Evidence: The present Manager of Chaplin Lodge has been employed at the home since May 2009. She has previous experience of managing a care home and 30 years experience of working within the care sector. She has achieved her Registered Managers Award and also has her NVQ level III and NVQ Assessors award in Health and Social Care. She has not yet applied to be the Registered Manager. Chaplin Lodge has had a number of Managers over the last couple of years and this has had an impact on the staff morale and the running of the home. The new Manager has only been at the home for approximately 6 months and from discussion is looking at ways of moving the home forward and providing quality care to individual residents. Care Homes for Older People Page 27 of 35 Evidence: On speaking with Staff and also relatives, some reported they had found the new Manager approachable and a new staff member stated there is no bitchiness, everyone works as a team. With regard to the comments received from the staff, these were mixed and included the manager is very supportive and approachable, Chaplin Lodge used to be a happy place to work, but now it is a very different place, no team work - we need to support each other, and the deputy manager does not work with us. The AQAA did report under the section of what they could do better we could explore more openly and honestly the issues that arise within team working and address these factors further when working towards our shared task of providing positive levels of care. Looking at the comments made, the feedback from the AQAA and also some of the issues raised by staff in other sections of the report, there are issues at the home around management and staffing that need to be addressed. There are a number of systems in place to assist in the monitoring of the quality of services Chaplin Lodge provides. Essex County Council completes annual visits to the home and the last report available was dated 1st December 2008. Monthly audits are also completed by the Manager and documentation was available to support this. A new Key Outcome Audit Tool has been introduced and this is to be completed on a monthly basis by the Manager. A Residents Meeting had occurred on the 16/10/09, but there was no evidence of any others. Visits from the Operations Manager also take place and specific audits are completed. The Manager confirmed that questionnaires had been sent out to relatives and residents, but she had only received seven back and these have not yet been collated or a report written. On viewing the comments book out in the foyer this included outside seating area could be improved. Green garden chairs are filthy and would like to see the painting extended into the residents bedrooms. My mother has a stained ceiling it has been like that for months. Also you can write your name in the dust on the lampshade. There was no place to write what action had been taken regarding these comments or whether they had been acknowledged or actioned. There are polices and procedures in place for residents monies, but these had changed since the last inspection. Each resident now has access to their own statement, but the money is pooled together in one bank account. Copies of three statements were viewed, these were in-depth and contained details of goods bought, the cost and monies left. The inspector was not able to complete an audit trail, due to the money not being kept at the home. There have been concerns over finances at the home and this is why the new system has been introduced. The new Administrator stated that an audit is completed once a week to ensure that the money is regulated and it also being over seen by upper management. It does state in the Service User Guide that assistance can be given with holding residents money, but it would be Care Homes for Older People Page 28 of 35 Evidence: pooled together. At the last Key Inspection it was made a requirement that staff should be appropriately supervised. Since being in post the Manager had produced a supervision matrix, which clearly showed which month staff had been seen and whether it was an observation, an appraisal or a planned supervision. On viewing this it was clear that all staff had received supervision and the Manager stated that she was working towards the recommended number. Meetings had also been organised for domestic staff, care staff, and senior staff and documentation was seen to confirm this. It was noted that there were minutes of the meetings and these included where areas of improvement were needed and also where things had been improved. Looking at the feedback from the staff questionnaires, when asked whether the Manager gave enough support and met with them, the responses included regularly (x1), often (x1), sometimes (x1) and never (x2). Staff and residents files are kept safe and Chaplin Lodge are registered with the Data Protection Act. Residents can have access to their files if requested. The Manager and Administrator were in the process of ensuring that both residents and staff files were up-to-date and contained all the required information. Folders had also been introduced to ensure that there was evidence available to identify that the National Minimum Standards and Regulations had been met. Regular checks had been done on the electrics, Legionella, fire checks, fire extinguishers, bath equipment, gas certificate and LOLER. On viewing the lift certificate it was noted that this had not been dated. The insurance certificates on show in the foyer were in date. Fire procedures could be found in the Statement of Purpose and there was a Health and Safety poster on the wall, which had been fully completed. Fire Extinguishers stated that some had been checked in 2008, but on further investigation the Manager was able to produced a certificate to show that checks had been completed in 2009, but the person completing the checks had not updated the fire extinguishers. This had been bought the companys attention and they had arranged for a further person to come out and re-check and update the fire extinguishers. It was noted during a tour of the home that in one bedroom the person was using oxygen, but there did not appear to be any warnings on the door. There was a maintenance book which recorded issues such as light bulbs needing changing, items that were not working, toilets that were blocked etc. These had been brought to the maintenance persons attention and then signed when completed. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 23(2)(b) The premises and garden 30/11/2008 must be kept in a good state of repair externally and internally and all parts of the care home must be kept clean and reasonably decorated. This is to ensure it is a safe and healthy environment for residents. Care Homes for Older People Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 12 Care at the home must be provided in a manner that respects the privacy and dignity of service users. This is in connection to ensuring staff are aware of how residents wish to be addressed, ensuring they are wearing their own clothes and taking account of the residents wishes and feelings when providing care. 26/02/2010 2 16 22 The copy of the complaints procedure shall inlcude the name, address and telephone number of the CQC. This is to ensure that residents and relatives are able to contact the CQC regarding complaints they have brought to the homes attention. 29/01/2010 Care Homes for Older People Page 31 of 35 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 3 16 22 Complaint made under the complaints procedure must be fully investigated. This is to ensure that relatives and residents are confident that their complaints will be listened to, taken seriously and acted upon. 26/02/2010 4 18 13 There must be systems in place to prevent service users being harmed or suffering abuse of being placed at risk of harm or abuse. Systems must be in place and used to ensure residents are protected from abuse and any issues are thoroughly investigated. 26/02/2010 5 27 18 There must be sufficient staff working at the care home to meet the care needs and health and welfare of the residents. Sufficient staff must be on duty to meet the needs of the present residents and meet their health and welfare. 29/01/2010 6 31 12 There must be systems in place to enable staff to maintain good personal and professional relationships 26/02/2010 Care Homes for Older People Page 32 of 35 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 with each other and with service users and management. This is in connection to trying to develop relationships with staff and enabling them to bring concerns and have them acted upon. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 1 You need to ensure that the old registration certificate is returned and a new one gained to show the correct details. It is recommended that you add a review date to your Statement of Purpose and Service Users Guide to provide clear evidence when this has been done. It is recommended that is is recorded when a copy of the Service Users Guide and Statement of Purpose is given to perspective residents. Ensure staff are aware of the importance of always clearly recording medication and the reasons for refusal etc. Continue to develop residents choice and person centered care within the home. Ensure there are sufficient staff on duty to enable staff to provide the care recorded. Ensure details of the meals on offer are clearly displayed for the residents. The issue around meal times and food being made available to residents between 7.30pm and 8.00 am the next morning needs to be addressed. A snack meal should be offered in the evening and the interval between this and breakfast the following morning should be no more than 12 hours. 3 1 4 5 9 14 6 7 15 15 Care Homes for Older People Page 33 of 35 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 8 26 Ensure there is a risk assessment completed on the present laundry system to ensure there is no cross contamination with the clean and dirty laundry and meets infection control requirements. Ensure that gaps in employment are investigated and a record written to explain the reason. The Manager needs to apply to the CQC to be Registered. Ensure the up to date lift certificate is in place for the next inspection. Ensure Regulation 37s are submitted to CQC to advise of any issues connected to the health and welfare of residents. 9 10 11 12 29 31 38 38 Care Homes for Older People Page 34 of 35 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). 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. 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