Inspection on 21/04/09 for Chesterfield Gardens 44 & 60

This is the latest available inspection report for this service, carried out on 21st April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chesterfield Gardens 44 & 60 11/10/07

Chesterfield Gardens 44 & 60 29/01/07

Chesterfield Gardens 44 & 60 01/11/05

Chesterfield Gardens 44 & 60 25/04/05

Chesterfield Gardens 44 & 60 20/08/04

Chesterfield Gardens 44 & 60 11/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chesterfield Gardens 44 & 60 Chesterfield Gardens 44 & 60 London N4 1LP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Shamash     Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Chesterfield Gardens 44 & 60 Chesterfield Gardens 44 & 60 London N4 1LP 02088094933 F/P02088094933 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): PRA Services (Psychiatric Rehabilitation Association) care home 7 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 7 The Registered Person may provide the following category 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 category: Mental Disorder, excluding Learning Disability or Dementia - Code MD Date of last inspection Brief description of the care home 44 & 60 Chesterfield Gardens are two terraced houses that operate as a single care home for seven adults with mental health needs. The home is run by the Psychiatric Rehabilitation Association (PRA) which provides a range of mental health services. The home is close to shops, pubs and public transport. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 7 Brief description of the care home 44 Chesterfield Gardens has three bedrooms for residents with a separate toilet and bath/shower room on the first floor and a lounge, kitchen/diner, toilet and staff office/sleeping-in room on the ground floor. 60 Chesterfield Gardens is similar in layout with a fourth resident bedroom on the ground floor instead of the staff accommodation. Both houses have an attractive rear garden. The home aims to support individuals with mental health needs to live in the community as independently as possible. Fees charged as of April 2009 are approximately 547.79 GBP/week. Chesterfield Gardens makes inspection reports and other important information about the home available to residents, their families and professionals. Reports can also be viewed on www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place over one day and lasted approximately six hours. The new manager of the service assisted with the majority of the inspection, and I was also assisted by two members of the staff members. A tour of both houses was undertaken and I had the opportunity to speak to all of the seven people living at the service at the time of the inspection. I also observed routines within the home, and met two visitors to the home. A variety of records, including care plans, staff files and health and safety documents, were examined, and information provided in the Annual Quality Assurance Assessment was taken into account as part of this inspection. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? People living at the home were being prompted and supported to attend regular healthcare appointments including visits to the dentist and optician. There was evidence that staff were being provided with detailed induction training and have current fire safety and food hygiene training to ensure that they work with residents safely and in line with best practice. The Annual Quality Assurance Assessment was completed for the home, when it was asked for, and a new comprehensive quality assurance procedure was being put in place for the home. The homes fire risk assessment had been updated to include greater detail to ensure the safety of people living and working at the home. All foods stored in the homes refrigerators were being labelled with the date of opening to ensure that residents health is protected by safe food handling procedures. A new manager had only been in post for a short time prior to this inspection visit, Care Homes for Adults (18-65 years) Page 7 of 32 however the overall impression is that with consistent management this service clearly has the capacity to achieve a good rating. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Peoples needs and wishes are fully assessed so that the home can be sure that it can meet their needs and preferences. Evidence: I had the opportunity to speak with all seven of the people living at the home. People living in both houses told me that they continued to be happy living at the home and that their needs were being met appropriately. One person told me that they were aiming to move out into more independent accommodation when this was possible. Another advised Its a good place to live. We get on well together. Detailed assessments were available in each care file inspected, indicating that comprehensive assessments including social, cultural and emotional needs, are undertaken prior to any person being admitted to the home. A continued high level of satisfaction described by people living at the home also indicates that the home has a track record of being good at selecting people who will benefit from the homes services, and that the needs and wishes of people living at Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: the home are being responded to appropriately. No new people had been admitted to the home since the previous inspection. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Staff are effective at assessing and responding to the needs of people living at the home and helping them to make decisions for themselves. People living at the home are supported to take appropriately calculated risks in order to develop their independence skills as far as possible. Evidence: I inspected three care plans, including records from people living at both houses. These identified the main needs of people living at the home and how these were being met. I also spoke to two staff members, who advised on how they assisted residents to achieve the aims set out in their care plans including assisting or prompting people with personal hygiene, cooking, budgeting and social and cultural needs. All care files inspected contained up to date care plans and risk assessments, although there remains more room for care plans to reflect person-centred approaches to Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: supporting residents. Staff had undertaken training in person centred planning, however there is room for this to be incorporated further into peoples care plans. All residents had goals recorded for them, but these tended to be primarily limited to goals regarding physical care needs. They would benefit from more varied goals including social, emotional, aspirational and recreational aspects of their lives. The members of care staff spoken to were aware of the need to provide guidance and support to residents where necessary, whilst letting them make their own decisions as far as possible. People living at the home told me that they could make decisions about when they wanted to have meals and what they had to eat, when to have a bath/shower or what time to go to sleep. They also said they had meetings where they discussed the running of the home and made suggestions about what they wanted to do, such as where to go on holiday. Staff support residents to take risks as part of a more independent lifestyle. One resident is now able to take short trips outside of the home independently, with staff support from a distance. Feedback from residents indicated that they enjoyed opportunities to do more for themselves. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is good at enabling people to get out and about and lead lives of their choices. They enjoy having good links with the local community and close contact with friends and family. People are supported to make choices for themselves about how they spend their time, including choices of leisure activities, educational and work opportunities. They are supported to have as much control over their lives as possible, but some might benefit from more choices of leisure activities. They are encouraged to help prepare meals at the home and consulted about the menus so that their preferences are taken into account, and a varied and nutritious diet is provided to them. Evidence: Most people living at the home attend workshops run by the provider organisation during the week, and one attends a gardening project on two days a week. Staff Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: advised that these placements continue to help people to maintain their ties to the community and to develop and maintain their social lives and functioning. The majority of people living at the home are able to go out and about in their local community independently. People told me that they go out shopping, and use local facilities such as the post office, dry cleaners, and local cafes. In addition some supported trips are arranged out to the cinema, pubs, parks and on outings further afield. Cultural needs are responded to with one resident going to a temple to worship when they wish to (although they usually receive family support with this), and supported to cook cultural foods. The manager advised that she has plan to further extend attention to peoples cultural needs within the home. The residents take it in turn to go out to the local shops to buy food for the home. Inhouse activities include playing board games, barbecues, gardening or having friends round. People said they could have visitors when they wanted to, and during the visit I encountered two friends who had come to visit one person living at the home. Residents spoke positively about how staff members respect their rights and give them responsibility. One resident told me that staff continue to support them to keep in contact with family members abroad. Inspection of records, alongside discussion with staff and residents indicated that there are still few organised activities taking place in the evenings and at weekends, with the exception of a recent trip to eat out in the Wood Green area. This clearly remains a choice on the part of some people living at the home but less so for others, particularly at weekends. Residents usually go on an annual holiday, and were looking forward to taking a holiday later this year. All residents have their own keys, and lockable cabinets within their rooms and staff have no access to personal/private space unless permission is received. Restrictions are kept to a minimum and where they are in place they are stated in the homes brochure or the contract. I observed that residents and staff continue to have good supportive relationships interacting in a relaxed way. People that I spoke to advised that they were consulted on menu choices and offered alternatives if they so wished. In the more independent home, residents choose to eat meals together, taking it in turns to cook, and these are an important social occasion Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: of the day. The manager advised that staff continue to spend time working with residents who have diabetes and high cholesterol, to encourage them to have a healthier diet. This was also documented in the care plans as appropriate. Im hoping to move out into my own flat eventually,one person told me. I observed all residents helping out with day to day chores within the home, including washing up, sweeping the kitchen floor, and cooking meals. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. The staff team is good at providing physical and emotional support to residents in a way that they are comfortable with. Residents are generally supported with their medication needs appropriately, however they would benefit from further safeguards put in place to protect them from risk of error. Evidence: Staff were observed to interact appropriately with residents in a way that recognised their individual needs and capabilities. A key worker system remains in place so that residents have a member of staff who takes a particular interest in supporting them. I observed service users accessing their monies in order to pay for dry cleaning - of items that needed washing and ironing (shirts and trousers). I was initially concerned that this was not appropriate in cases where particular service users are not capable of ironing their clothing themselves, and therefore this would be a task expected to be undertaken/supported by staff members. Discussion with the provider following the inspection visit, indicated that this was only undertaken for trousers that needed special care and attention, and that the next of kin of an identified individual were Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: happy with this arrangement. Residents told me that they thought their needs were being met and that staff were good at responding to their individual needs. An improvement was noted in the recording of support provided to people living at the home to attend dentist, GP and chiropodist appointments. At the time of the insepction visit there was insufficient evidence that the people living at the home are prompted to attend regular opticians appointments. However evidence was provided that people had been supported to attend opticians appointments following the inspection, and the provider is aware of the need for a format for recording these appointments that makes them easy to monitor, in order to safeguard residents health and welfare. At the time of the inspection no people living at the home were self-medicating, although the manager advised that this remains under review. The records relating to the administration of medication to residents were up to date and accurate. As required the storage temperature for medicines was being monitored. Although some medicines were being provided in blister packs for residents, others were being secondarily dispensed into dossett boxes by staff members to two identified residents. The manager advised that this procedure was being witnessed and checked by appropriately trained staff members, however records for this were insufficiently clear. Following the inspection the provider contacted the CQC to advise that where possible the practice of secondarily dispensing medicines would cease, and that they had contacted the relevant healthcare professionals to arrange for the remaining medicines to be dispensed into dosette boxes by a pharmacy. In addition the pharmacy was not providing descriptions of medicines provided in blister packs, this is needed so that staff can accurately sign these into the home. Finally the date of opening was not recorded on a creme prescribed for one particular resident, this should be undertaken so that these can be discarded within the required period, to ensure that the medication needs of people living at the home are met safely. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system so that people can be confident that their complaints and concerns will be listened to and acted on. People living at the home benefit from adult protection procedures that protect them from abusive practices. Evidence: The home has policies and procedures in place in relation to reporting and investigating complaints with each resident given a copy of the complaint form. The complaint record showed that no complaint had been made since the previous inspection. Residents said they felt able to make complaints and raise issues if they needed to. It remains recommended that a record be kept of comments and suggestions made by residents on the running of the home so that the influence residents have on the service provided at Chesterfield Gardens can be measured more effectively. There had been no new incidents in relation to adult protection in the home since the previous inspection, and prior to this the home had demonstrated a good record of taking appropriate action to meet safeguarding adults concerns. Recruitment procedures are sufficiently rigorous to ensure the protection of people living at the home from abuse. Staff have had training in Safeguarding Adults and the home has Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: appropriate adult protection and whistle blowing policies. Staff members on duty were aware of how to respond to incidents or allegations. Residents are also provided with information about their rights within the homes handbook. Residents monies kept by the home are checked by two members of staff at the end of each shift to ensure that that there is a proper record kept, with any discrepancies identified quickly. Care Homes for Adults (18-65 years) Page 20 of 32 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. People live in homely, clean and comfortable environments, however it is in need of a number of improvements to ensure that the houses continue to provide people with a pleasant environment. Evidence: The two houses on Chesterfield Gardens provide a homely and comfortable environment for residents. People living in the home told me that they were generally happy with the decor and furnishings in both houses. Both homes were kept clean with a cleaner coming into both houses regularly as well as residents (with support from the staff team) taking responsibility to keep the houses tidy. Paper towels were being provided in the bathrooms/toilets at both homes to ensure appropriately hygienic facilities for people living at the homes. Peoples bedrooms were personalised according to their choices, and facilities within communal areas were generally decorated appropriately. The laundry room at 60 Chesterfield Gardens had recently been painted, gardens in both houses had been improved, with a shed provided for house 44, and pipes within the lounge at house 44 Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: had been covered over to some extent - however this should be undertaken in a more complete way so that they, and the boiler, are covered, up to the ceiling in the form of a cupboard. A number of issues needed to be addressed within both homes, including worn sofas at 44 Chesterfield Gardens. This home would also benefit from the communal areas becoming more personalised to the people living at the home. Staff and people living at the home also advised that there had been recent problems with central heating on an ongoing basis. The room next to the bathroom was in need of redecoration around the radiator, and there were visible problems due to damp around the laundry room, kitchen and downstairs toilet walls, which need to be addressed prior to redecoration. The paintwork on the outside of the homes should be cleaned or redecorated, and the kitchen cupboards - particularly at house number 44, are worn, making them hard to keep clean, and therefore in need of replacement. At 60 Chesterfield Gardens, the resident in the downstairs bedroom wished for their room to be repainted a lighter colour, and for their carpet to be changed, the kitchen ceiling was in need of redecoration and, the carpet in the front upstairs bedroom was very worn and in need of replacement. Finally it remains recommended that a computer with internet access be provided for the staff office, for more efficient running of the home, and possibly for residents to develop computer skills. Staff advised that the television in the staff sleep-in room (and office) was not operational, and a replacement for this should be considered. Following the inspection visit, a schedule was provided to the CQC detailing how and when these improvements would be undertaken. Care Homes for Adults (18-65 years) Page 22 of 32 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from a committed and experienced team of staff at the home who have the skills and training needed to meet their needs. They are protected by the home having appropriate recruitment procedures for new staff. Residents are supported effectively by staff who attend regular training courses. However insufficiently regular staff supervision may place residents at risk of not receiving high quality support at all times. Evidence: I had the opportunity to speak with two staff members and the new manager for the home. Most staff at the home have worked there for a number of years and have built up a good knowledge and understanding of the needs of all the residents. A good deal of positive feedback was received from people living at the home, indicating that they felt well supported by staff at the home. I inspected three staff files and these contained sufficient information to demonstrate that appropriate recruitment checks had been undertaken to ensure that residents are protected from having unsuitable staff working at the home. These checks included two written references and enhanced CRB disclosures. Discussion with the manager indicated that she is aware of the appropriate procedures to follow when recruiting Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: staff. In the previous Annual Quality Assurance Assessment the responsible individual advised that the homes recruitment practice is underpinned by an equal opportunities policy, and that the ethnic mix of staff members currently reflects the ethnicities faiths and gender of people living at the home. Certificates maintained in files indicated that all staff have completed relevant NVQ Level 3 qualifications, as well as attending relevant training courses when necessary. This exceeds the national minimum standards for staff qualifications, and the service is commended fo this high standard of training provision. The staff members spoken to advised that they had completed training in essential areas, such as food hygiene, health and safety, administering medication and first aid. Staff have a good understanding of the individual needs of each resident, and had undertaken training in person-centred planning which focuses on the individual needs and wishes of residents. Staff told me that they had had thorough inductions prior to commencing work at the home, and this was confirmed by information provided in two of the three staff files inspected. Inspection of records and discussion with staff indicated that they had little in the way of formal supervision sessions since the previous inspection. This is predominantly due to the staff team not having a manager until shortly before this inspection visit. The new manager was aware that this was an area still to be addressed. Training profiles were being maintained at the head office for the service, so that any gaps in training, or updates due, can be identified and addressed efficiently, to ensure that staff provide a high standard of care and support to people living at the home. Care Homes for Adults (18-65 years) Page 24 of 32 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well run so that people living there benefit from having their individual needs and preferences responded to. Residents contribute to the way in which the home is run, and benefit from an improvement in quality control procedures to ensure that high standards of care and support are maintained at all times. Appropriate health and safety procedures are generally in place to ensure that people living at the home are protected from harm. Evidence: A new manager had been appointed to work at the home, a short time prior to this inspection visit, however the home had been without a manager for the majority of the year prior to this inspection. Discussion with the manager indicated that she had sufficient enthusiasm, experience and qualifications to undertake this role, and that she is receiving support from the provider organisation as appropriate. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: Staff and residents meetings were being held at the home during which people are able to put forward their ideas and suggestions on how the home is run. Meeting minutes indicated that they were used for consultation about the running of the home, such as the destination for the next holiday, the menu for the following week, which days people do their washing and cooking the evening meal. Records of resident meetings indicated that these are held regularly, and that residents had been using these to give their view about the home. Staff advised that regular monthly visits were being undertaken by a representative from the provider organisation, and CQC was provided with recent reports of these visits following the inspection. A current Annual Quality Asurance Audit had been provided for the home as appropriate, and the registered provider advised that a new comprehensive quality assurance system was being put in place for the home, and that a gap analysis had recently been undertaken. The new system is outcome orientated and involves learning from mistakes. A rigorous procedure was in place for checking residents monies, stored for safekeeping by the home, including checks at each shift handover. As required, a log of property stored e.g. bank books was also maintained. The system now includes information about when each bank book/cards is taken out, or returned to the home, but it is recommended that these items should also be checked on each shift handover, alongside checks of monies held for safekeeping for each resident. Health and safety records were looked at, including gas and electrical installation certificates, portable appliances testing, water quality and fire safety and accident reports. These records were maintained up-to-date and accurate. as required at the previous inspection a new more detailed fire risk assessment was provided for both houses, and all relevant perishable items stored in the homes refrigerators that were opened had been labelled with the date of opening as appropriate. The only issue of concern encountered within the home was that some cleaning materials were found upstairs in the bathroom at house 44, although risk assessments for residents in this house indicated that they should not access these unsupervised. Care Homes for Adults (18-65 years) Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 32 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 20 13 The registered person must ensure that the pharmacies provide descriptions of medicines for people living at the home packed in blister packs so that staff can accurately sign these into the home, and that the date of opening is recorded on any ointments, so that these can be discarded within the required time period, to ensure that the medication needs of people living at the home are met safely. . 17/07/2009 2 24 23 The registered person must 26/06/2009 ensure that the following issues relating to the homes environment are addressed: At 44 Chesterfield Gardens, new sofas should be provided, and the problems with central heating must be Care Homes for Adults (18-65 years) Page 28 of 32 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 addressed. The room next to the bathroom needs redecoration around the radiator, and issues of damp around the laundry room and kitchen must be addressed prior to redecoration. A schedule should be provided for repainting the external windows, repainting and changing the carpet in the downstairs bedroom, painting the kitchen ceiling, and changing the carpet in the front upstairs bedroom, and an identified residents internal window frame, at 60 Chesterfield Gardens. The schedule should also include redecoration/ cleaning of external paintwork, and provision of new kitchen cupboards and completely covering the pipes and boiler in the lounge at 44 Chesterfield Gardens, for the comfort of people living and working at the home. . 3 35 18 The registered persons must 10/07/2009 ensure that all staff are provided with supervision sessions at least six times annually and annual Care Homes for Adults (18-65 years) Page 29 of 32 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 appraisals, and that records are available to evidence this, to ensure that staff provide a high standard of care and support to people living at the home. . 4 42 13 The registered person must ensure that all chemical cleaning materials are locked away when not in use, for the safety of people living at the home. . 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 29/05/2009 1 6 It is recommended that the training undertaken by staff in person centred support, is used to develop more detailed and accessible care plans, including more varied goals for people living at the home, to ensure that social, emotional, aspirational and recreational needs are addressed. It is recommended that more organised activities be offered to residents at weekends, to ensure that they are encouraged to live stimulating and fulfilling lives. It remains recommended that a record is kept of comments and suggestions made by residents on the running of the home so that the influence residents have on the service provided at Chesterfield Gardens can be measured more effectively. It is recommended that a computer and printer be provided in the staff office, for more efficient running of the home, and possibly for residents to develop computer skills. Page 30 of 32 2 14 3 22 4 24 Care Homes for Adults (18-65 years) 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 Provision of a television in the staff sleep-in room should also be considered. 5 41 It is recommended that a checklist of all bank books/cards (or other property) kept for safekeeping in the homes safe, is completed alongside records of any monies stored at each handover shift, for the further protection of people living at the home. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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