Inspection on 18/08/08 for Chaseview Care Centre

This is the latest available inspection report for this service, carried out on 18th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chaseview Care Centre 17/05/06

Chaseview Care Centre 14/11/05

Chaseview Care Centre 26/05/05

Chaseview Care Centre 15/12/04

Chaseview Care Centre 26/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Chaseview Care Centre Off Dagenham Road Rush Green (hospital Site) Romford Essex RM7 0XY Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 18th August 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chaseview Care Centre Address Off Dagenham Road Rush Green (hospital Site) Romford Essex RM7 0XY 020 8517 1436 020 8595 8960 hoylejo@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Jonathan Hoyle Care Home 120 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (90) of places Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 90) Dementia - Code DE (maximum number of places: 30) (of the following age range: 50 and over) The maximum number of service users who can be accommodated is: 120. 25th January 2007 2. Date of last inspection Brief Description of the Service: Chaseview Care Centre is a registered care home with nursing operated by BUPA, a large, private sector provider with many similar homes across the UK. It is situated in a residential part of Romford, on a main bus route to both Dagenham and Romford town centres and rail/tube links. There are 120 places in total, spread across four houses, each of which provide 30 places and the fees range from £600. - £700 for residential and £750 £850 for nursing with the RNCC element to be deducted following the nursing assessment by the Primary Care Trust. A copy of the Statement of Purpose and Service User Guide to the home is made available to new residents and their families and copies of these documents are available on the main reception and on each unit. A copy of the Service User Guide was in each bedroom and copies of the most recent inspection report is on each unit, and available on request. Ford House offers specialist nursing and personal care for older people with dementia; Kennedy House and Nicholas House each provide nursing and personal care for older people who have physical and psychological disabilities/illnesses; and Hart House provides residential care for older people Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 5 whose nursing needs can be met by visiting professionals. Each house has a similar layout of 30 single, en-suite, bedrooms, communal bathrooms, shower rooms, and toilets, large lounge/dinning area, small kitchen, staff office, sluice room, and clinic room. All areas are fully accessible to wheelchair users, and have aids to assist people with physical disabilities. The accommodation is spread over two floors, and there are lifts in each house. A central kitchen and laundry service all four houses. Two of the houses have sensory gardens and service users have access to generic garden spaces. Four staff are employed specifically to organise activities, and the nursing and care staff are supported by a team of catering, domestic, administrative, and maintenance staff. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use the service experience good quality outcomes. The unannounced inspection was undertaken on the 18th August by two inspectors, Mrs. Sandra Parnell-Hopkinson, lead inspector, and Mrs. Gwen Lording, to ensure that the home was given a detailed assessment, taking into consideration the wide range of service users that are in receipt of care and support. The inspection process included a tour of the whole home, discussions with the manager and other staff, discussions with residents and relatives, feedback from questionnaires and social and health care professionals. Information was also gathered from the annual quality assurance assessment, which had been completed by the care home manager prior to the inspection, case tracking, staff recruitment processes and other documentation associated with the care home. What the service does well: The home had recently undergone a major refurbishment programme, with new furniture and furnishings. Where previously some bedrooms had not been carpeted, this has now been addressed and these rooms now have carpet. It was evident throughout the home that residents are supported to personalise their bedrooms with personal effects, items of furniture, as well as choosing colour schemes. They have access to communal spaces both indoors and outdoors, including the use of two sensory gardens, which are pleasant and well maintained. Signage and décor was apparent on Ford which accommodates residents living with dementia. The organisation’s Quest system is now in use on all of the units and this has added to the improvements being made around recording and care planning. The service continues to maintain professional relationships with external agencies in ensuring that the health and welfare needs of residents are adequately provided for. Referrals are made, when necessary, to the speech and language therapist, dietician and nutritionist, tissue viability nurse, the diabetic nurse and St. Francis Hospice in relation to palliative care. The organisation also utilises the expertise of their tissue viability specialist, who is Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 7 involved in reviewing, monitoring and advising on maters relating to the management of good pressure care. Residents and their relatives were generally happy with the care being provided at the home, and one resident told us “most of the girls are really nice and do anything for you.” What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 (standard 6 is not applicable to this service) People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People using the service benefit from having updated information about the services provided by Chaseview. They also benefit from having a statement of their terms and conditions, outlining their obligations and those of the organisation. Detailed and full assessments are carried out to ensure that service users are appropriately admitted to the home and this helps to provide assurances that their needs would be met. EVIDENCE: Individual records are kept for each resident and a number of files were examined on all 4 units. All files contained a comprehensive pre-admission assessment, and there was evidence that a further assessment is undertaken on admission to the home and a care plan is compiled from the information contained in both of these assessments. Input is included from the resident, Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 11 wherever possible, family members where appropriate, and health and social care professionals. Pre-admission visits to the home by the prospective resident, wherever possible, and family/friends are encouraged. This gives people an opportunity to talk to residents, staff and visitors and helps them to assess the home’s facilities and the ability of the service to meet the individual’s needs. It was noted in the Dementia unit that detail is given to obtaining information around a person’s existing abilities with regard to ordinary activities of daily life and their life histories. This information is important and cannot be gathered without input from family and friends. Such information is incorporated into the resident’s care plan to enable the staff to provide the right level of care in both health and social areas. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. People’s health, personal and social care needs are set out in an individual care plan, and they can be confident that their health care needs will be fully met. People are protected by the home’s medication policies and procedures and by staff being trained in this area. Generally, people using the service can feel that they are treated with respect and their right to privacy upheld and also that at the time of their death, staff will treat them, and their family, with care, sensitivity and respect. EVIDENCE: New care planning documentation Quest, has been introduced and this is in the second phase of implementation. All staff have received training in its use. Individual care plans were available for each resident and three residents on each unit were case tracked and their care plans and related documentation inspected. There was a good level of detail and personalisation in the care plans seen. It was evident from viewing care plans and talking to staff, residents and visiting relatives that individual health care needs were being Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 13 met. One visiting relative told us: “I am very confident that staff are taking care of my mother. She is prone to chest infections but the staff are very aware and get the GP involved without delay. The family have peace of mind as they know she is being given very good care.” Individual preferences of residents around gender care, were clearly recorded in care plans as was religious and cultural needs and preferences. Care plans showed that nutritional screening is being undertaken on admission and that a record is maintained of nutrition, including weight loss or gain. Where concerns are indicated there is evidence that appropriate action is taken, with an initial referral to the GP and then to a dietician or nutritionist. Residents are routinely weighed on a monthly basis, or more frequently if a significant risk or concern is identified. The files viewed also had care plans around sleep and night care wishes of the individual resident. We found that the documentation/health records relating to wound management; management of insulin dependant diabetes and catheter care were generally good. Professional advice and input are sought from specialists such as a tissue viability nurse; diabetic nurse and speech and language therapist. We also saw evidence that residents are able to access GP, dental care, chiropody services, optician and other medical services as required. A number of monitoring charts were examined including blood sugar monitoring, re-positioning charts and fluid intake/ output monitoring charts. These were generally found to be in good order. However, the introduction of such charts should not become common practice, but only be used to monitor a specific concern for a period of time before making a referral to the specialist health professional. Using charts as the norm often results in staff not completing these at the appropriate time and in a meaningful manner. This was discussed with the manager during the inspection process. Risk assessments are routinely undertaken on admission for all residents around nutrition, manual handling, continence, falls and pressure sore prevention. We found that risk assessments are being reviewed and updated monthly are more frequently as the need indicates. There has been some development of care plans around end of life wishes and needs, and where care plans were in place there was a good and sensitive level of detail. However, some further development is still needed around this area. Daily records are being kept but these should be more reflective of the outcomes identified in the care plans. In this way the monthly reviews become more meaningful and the necessary care plans can be adjusted to demonstrate that outcome have been met, and new ones identified. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 14 We saw staff generally interacting well with residents on all of the units, and saw that staff knocked on bedroom doors before entering. Comments made at the 2007/08 annual service review were that bed linen was not changed on a regular basis. We discussed this with the manager and also spoke to some residents and all confirmed that bed linen was changed on a regular basis. Also the manager did confirm that there had been a shortage of linen at one time of which he was not made aware. But as soon as he was made aware of this situation an immediate order was put in for more linen. No further comments or complaints have been received in this area. An audit was undertaken on each unit for the handling and recording of medicines within the home and a sample of Medication Administration Record (MAR) charts were examined. There are clear medication policies and procedures for staff to follow. Discussions with staff and the review of medication records showed that staff are following the policies and procedures, so as to ensure that residents are safeguarded with regard to their medication. Where a resident had an allergic reaction to either medication or food this was recorded in the care plan and had a specific plan of care to manage the allergy. A record was also being maintained on the (MAR) chart. However, it is strongly recommended that where such an allergy has been identified it is recorded more prominently on the front sheet of the resident’ file. This is to reduce the risk of such allergies being overlooked, especially in an emergency situation. Several comments have been made regarding residents sometimes having to wait a long time for a member of staff to answer the call bell. We did discuss this with the manager and rotas demonstrated that the staffing levels have not dropped, although sometimes due to a staff member calling in sick levels were not always in line with policy. However, the manager has undertaken to review staff deployment on all units, so that at all times residents’ needs can be met effectively. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. Residents can enjoy a full range of activities either in groups or on an individual basis. People are afforded choices and they are encouraged to maintain their networks of friends and relatives. Generally residents benefit from having their nutritional needs adequately provided for at Chaseview, but choices in this area are often made by staff for some residents, especially those with dementia. EVIDENCE: We observed breakfast being served on Kennedy and lunch being served on Nicholas and Ford. Meals are served in the large lounge/dining rooms or from small lap tables in the lounges or residents may choose to eat in their bedrooms. On Nicholas and Kennedy units tables were routinely laid with tablecloths, placemats, napkins, cutlery, glasses, condiments and flowers, but this was not always the case on Ford unit. Although we did not observe meals being served on Hart, the tables were laid as for Nicholas and Kennedy and included menus being provided on the tables. The settings were very Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 16 congenial and there was a nice relaxed atmosphere on Kennedy and Nicholas units. The meals on all units were well presented, and residents on Kennedy and Nicholas, who required assistance, were being given this in a sensitive and encouraging manner. One resident told us: “The food is good and there is plenty to choose from. The best thing at breakfast is the toast – fresh and still hot when you get it”. However, on Ford unit many of the residents require a lot of support, supervision and assistance at mealtimes. It was evident that staff were very much under pressure to be able to give the correct assistance. It was also evident that residents are asked their choice of meal the day before. This is totally unacceptable for people living with dementia, as many of them will not remember what they have been asked 5 minutes previously. This was discussed with the manager during the inspection and we are hopeful that changes will be made to enable residents living with dementia to make meaningful choices at the time of the meal. We were also told that the unit does have pictorial menus but we did not see the evidence of these during our visit to Ford. One resident on Ford was heard shouting continually during lunch, and a visiting relative of another resident confirmed that this was usual. Generally she was being ignored by the staff who were busy serving lunch, However, when the resident was spoken to by us she was able to communicate in a limited manner, and she did stop shouting. Obviously this resident requires a lot of staff input, but it is important that such input is given both for the benefit of this resident, and also for the benefit of other residents on the unit. This is an example where staffing deployment needs to be reviewed. On Hart, Kennedy and Nicholas Daily newspapers were available for residents to read. Again the provision of magazines on Ford could be beneficial for some of the residents, even they are just turning pages because this does enable them to maintain contact with the world around them, even if to a limited degree. A visit was made to the main kitchen and we were able to discuss the storage, preparation of food and menus with the head chef. He was able to demonstrate a good knowledge and understanding of the importance of well balanced and well presented meals, and those residents with special therapeutic dietary needs. There is a vegetarian option on the daily menu and fresh salad and fresh fruits are available at each meal and on request. A cooked breakfast is available on the daily menu and on the day of the visit thirty residents had chosen one variety or other of this option. The use of full cream milk, butter and cream is used wherever possible to supplement the diets of those residents with reduced food intake or diminished appetites. There is a ‘Nite Bite’ menu available in the evenings but the take up is reported to be low and not varied in choice. Most requests are for toast and jam, which can usually be provided from the stock provisions in the servery kitchen located on each unit. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 17 Visiting times are flexible and relatives/friends are encouraged to visit, and are able to use the small servery kitchens to make themselves hot drinks. Also visitors can choose to have a meal with their friend/relative, and there was evidence that one visitor does this on a regular basis. One relative told us: “I am always made very welcome even if I visit late in the evening and can make myself a drink”. On Kennedy and Hart unit one of the activity co-ordinators was serving a selection of pre-lunch drinks to all residents including, sherry, wine and low or non-alcoholic drinks. One resident told us “I really enjoy my beer before lunch.” This helps to stimulate the appetite of residents and is seen as being important in considering the nutritional needs of residents and the overall dining experience. A list of forthcoming activities is available on all of the units and some of these activities are for all of the units together, or some are specific to each unit. Some residents enjoy trips out and festivals are celebrated throughout the home. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. People can be confident that if they complain they will be listened to and taken seriously with the necessary action being taken by the manager. People will also be protected from abuse through staff training and awareness, and if any abuse is evident from a member of staff, the necessary robust action will be taken against that member of staff. EVIDENCE: We were able to speak to several residents and relatives who felt confident that they knew who to complain to, and that they would be listened to. Residents also told us that they were also aware as to how to complain if they were unhappy with their care. We saw evidence in files and in talking to the manager that all complaints were looked at and investigated thoroughly. The organisation also requires a regular audit of all complaints, and it was also evident that lessons learned from a complaint are used to improve the service provision to residents. An adult protection procedure was in place and was available to staff. The organisation has provided adult protection training for staff and this has boosted their confidence in dealing with allegations and/or suspicions of abuse. From the discussions held with staff, they were aware of the action to be taken if there were concerns about the welfare and safety of residents. Staff were Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 19 also aware of the organisation’s whistleblowing policy, and a member of staff has recently used this policy which has resulted in a member of staff being suspended pending an investigation into alleged abuse of a resident. This issue is still the subject of an ongoing investigation by the local authority’s safeguarding team and the organisation. The manager followed and implemented all of the correct procedures, and the staff are to be commended for using the whistleblowing process in the best interests and safety of the residents at the home. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. People using this service live in a safe, well-maintained environment which is clean, pleasant and hygienic. EVIDENCE: We did a tour of the premises, at the start of the visit, accompanied by the manager, and all areas were visited later during the day. The inspection commenced at 08:30am and on arrival we found the home to be clean, tidy and there were no offensive odours. We found this to be the case on all units and areas of the home at all times throughout the inspection. Since the last inspection there has been a full refurbishment of the home including new furniture, furnishings, carpets and improved lighting in the corridors. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 21 Some bedrooms were seen by invitation, whilst others were seen because doors were open or rooms being cleaned. All of the bedrooms seen were very personalised and reflective of the occupant’s culture, religious and personal interests/hobbies. We spoke to one resident who likes to use her own bed linen and she told us “I am happy using my own bed linen and my son takes this home to wash for me.” There are still areas of the home where carpeting either needs to be replaced or deep cleaned, and also areas where the paint work requires attention. This was discussed with the manager during the inspection. We visited the laundry and this was found to be clean, with soiled articles being stored appropriately pending washing. The laundry is staffed from 6 am to 4 pm seven days a week. Personal protective clothing and equipment were available and in use. Hand washing facilities and hand sanitizers are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. The garden areas were well maintained and had seating areas for use by residents. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 29 and 30 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. People using this service generally receive a good standard of care from a staff team that is motivated, committed and provided with specialised training to carry out their jobs. Generally staffing numbers are appropriate to meet the needs of the service user group, although staff redeployment must be reviewed to ensure that the needs of all residents can be met at all times across all areas of the home. The organisation’s recruitment processes are robust and act as a good safeguard to protecting vulnerable people. EVIDENCE: We inspected staff rotas on all 4 units. The staffing levels and skill mix of qualified nurses and care staff, on all units appeared sufficient to meet the assessed nursing and personal care needs of the residents. However, some feedback from residents and relatives indicated that there are times when they have to wait a considerable time for a member of staff to meet their needs. This can either be waiting a lengthy time for assistance to the toilet or other such personal care. Also as previously stated some residents require more support and assistance with eating, and staff appeared to be under pressure at this time. On some unit we did observe that care workers were being effectively deployed to ensure that residents choosing, or needing to remain in their bedrooms were being cared for appropriately. However, in addition to serving meals and assisting residents to eat, two members of the care staff Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 23 from all units have to go to the main kitchen at each mealtime to collect the hot trolley. Whilst the kitchen is in relatively close proximity to all units, this effectively means that the staffing numbers are depleted by two on each occasion. Care staff should be wholly engaged in undertaking tasks around meeting residents personal and social care needs. It is strongly recommended that ancillary staff undertake these portering duties. Effective team working was observed throughout the visit and staff were mostly interacting well, both with each other and the residents. Two senior care assistants who have worked in the home for more than five years told us: “We work as a team together and communication between us is good”. The home operates a key worker system, and in discussions with staff we found that they were very knowledgeable about the residents and their individual needs as identified in the care plans we case tracked. We inspected the files of two of the most recently recruited staff, a qualified nurse and a care assistant. These were found to be in good order with necessary references, enhanced Criminal Records Bureau (CRB) disclosures and application forms duly completed. A valid Nursing and Midwifery Council (NMC) PIN and statement of entry are also obtained for qualified nursing staff. All elements of recruitment are accurately recorded and all required documentation is obtained prior to the commencement of employment. The organisation is able to demonstrate that they operate a proactive recruitment procedure in line with equality opportunities. The home has a designated training co-ordinator who is also a head of care. She co-ordinates the training programmes and is also responsible for delivering in house training. She is a qualified practise based teacher/ assessor and has attended a mentorship course. The home has an agreement with City University to take two student nurses on 8-week placements for the adult nursing placement module of their training. There are two designated training rooms, which are well equipped and resourced with training materials. We looked at the current training records which showed that staff have received training in moving and handling, health and safety, safeguarding vulnerable adults, infection control and understanding dementia. There is an in house training programme for all staff on the Mental Capacity Act 2005, and its implications on the delivery of care to vulnerable people and equality and diversity. Nursing staff have undertaken training in managing violence and aggression, syringe drivers and palliative care. There are four key members of nursing staff that have been trained and assessed as competent to undertake intravenous cannulation and phlebotomy. This means that where appropriate, residents can have blood samples taken by nurses qualified to do so, thus avoiding unnecessary trips to hospital. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 24 We were told that approximately 70 of care staff are qualified to National Vocational Qualification (NVQ) level 2 or above and the next cohort are currently being registered. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 36 and 38 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. People using this service can feel confident that they live in a home which is run and managed by a person who is fit to be in charge and able to discharge his responsibilities fully. People can be confident that the home is run in their best interests, that their financial interests are safeguarded and that staff are appropriately supervised and that their, and the staff’s health, safety and welfare are promoted and protected. EVIDENCE: We are satisfied that the home is run in the best interests of the residents, by a person who is qualified and competent to manage this large service. The manager is aware of improvements that are still necessary especially around staff deployment at critical times such as meal times, appropriate use of Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 26 monitoring charts and improvements to daily recordings to ensure that these are reflective of the outcomes desired and identified in the care plans. Sound arrangements were in place for the monitoring the quality of service provision in the home. Monthly provider visits, as required under regulation 26 of the Care Home Regulations 2001, are carried out and the registered manager and his deputy carry out quality audits of the service. One example is ‘a resident of the day’ audit, which looks at the care planning and meeting the care needs of service users. Reviews were also regularly held for service users. It was noted that service users and their relatives are now more involved in the home and records of meetings held were presented as evidence of this. The organisation carries out its quality assurance checks annually and staff have access to professional advice from specialist nurses. The annual quality assurance assessment, required by the Commission under Regulation 24 of the Care Homes Regulations 2001, was completed by the manager and this was comprehensive and included the necessary areas for improvement. We were satisfied that the financial interests of residents are safeguarded by the robust financial policies and procedures. All residents who have a personal account with the organisation receive interest on monies held which is credited to their account on a monthly basis. Adequate insurance arrangements were in place at the home and there were records of all financial transactions available for inspection. Adequate arrangements are in place for the supervision of all staff with care staff having more frequent sessions as required by the national minimum standards. Records viewed indicated that supervision covered all aspects of care practice, the philosophy of care and career development. Discussions with staff informed us that they were happy with the support they received in supervision and most felt that their personal and professional needs were met. There were arrangements to ensure that volunteers receive training that is appropriate, so that their contributions to the service do not put residents at risk. Records throughout the home are maintained in a secure manner and in line with statutory requirements. All maintenance records, including equipment such as hoists and wheelchairs, fire safety, lift maintenance and water temperature checks, were viewed and found to be up to date and in good order. Safety signs were appropriately posted throughout the home and a clear system is in place to ensure that maintenance books are completed in a timely manner across all units. The maintenance staff initials, on a daily basis, entries logged in these books. Records of all accidents/incidents were in place at the home, and safeguarding incidents are dealt with in accordance with policies and procedures in place within the service. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12/13 Requirement Timescale for action 30/09/08 2 OP7 12/13 3 OP27 18 The registered persons must ensure that daily recordings are reflective of the outcomes identified in the individual resident’s file. This will ensure that the monitoring of outcomes is effective in the ongoing care needs of the residents. The registered persons must 30/09/08 ensure that monitoring charts are used appropriately and when necessary and that these are completed at the time and not retrospectively. This is in the best interests of the residents and will give a more accurate picture of the desired outcomes. 15/09/08 The registered persons must review staff deployment to ensure that the needs of all residents can be met at all times. This will ensure that residents do not have to wait long periods for their needs to be met, or go without the necessary assistance and support required at meal times. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is strongly recommended that allergies are prominently recorded at the front of each person’s file (where necessary) to avoid such allergic reactions being overlooked in an emergency or when using agency staff. Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chaseview Care Centre DS0000015586.V370157.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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