Inspection on 03/03/06 for Alder House Cheshire Home

This inspection was carried out on 3rd March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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

Alder House Cheshire Home 07/10/08

Alder House Cheshire Home 31/10/06

Alder House Cheshire Home 09/06/05

Alder House Cheshire Home 13/01/05

Alder House Cheshire Home 27/05/04

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Three Forests Cheshire Home Lambourne Road Chigwell Essex IG7 6HH Lead Inspector Gaynor Elvin Final Unannounced Inspection 3rd March 2006 11:30 Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 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 Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 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 Adults 18-65. 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. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Three Forests Cheshire Home Address Lambourne Road Chigwell Essex IG7 6HH 020 8500 8491 020 8500 4660 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) www.leonard-cheshire.org.uk Leonard Cheshire Mr Dilip Kumar Mahadeo Care Home 19 Category(ies) of Physical disability (19) registration, with number of places Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, under the age of 65 years, who require care by reason of physical disability (not to exceed 19 persons) On completion of the final phases of development a building regulation certificate must be sent to the Commission 9th June 2005 Date of last inspection Brief Description of the Service: Three Forests is a care home registered to provide care and accommodation to fifteen people with physical and sensory disabilities. The home is part of the Leonard Cheshire Foundation and Mr Dilep Mahadeo is the Registered Manager. Three Forests is a purpose built single storey building set in beautiful gardens incorporating a large lake, located in a semi rural area of Chigwell, Essex on the border of London. A bus route provides access to the home, although the bus stop is approximately 10 minutes away by foot. There is a local train station and Woodford station is approximately 30 minutes away. Single accommodation is adapted for wheelchair users and has en-suite toilet and bathroom facilities. The home is set in attractive and mature grounds which are well maintained and accessible to wheelchair users. Each room opens out onto its own well maintained individual garden and patio area with garden seating. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place one day in March 2006 over five hours. All of the key standards and the intended outcomes have been assessed in relation to this service during at least two inspections for the current inspection year (April to March). To view the assessment of standards and outcomes not included within this report, please refer to the previous published report dated 9th June 2005. This inspection focused on the key National Minimum Standards and intended outcomes not assessed in the previous inspection, looking at working practices, supporting documentation and records, as well as progress made in addressing the statutory requirements and good practice recommendations made in the previous inspection report. This report refers to the service users as residents, as this was the preferred term of address expressed by the residents, throughout Cheshire homes. What the service does well: What has improved since the last inspection? What they could do better: A more robust approach must be taken to implement an active care planning process to inform care staff of agreed, planned and consistent support to promote well-being and optimal independence and ensure regular review and evaluation. More attention needs to be given to ensure mandatory training for staff is updated accordingly and specific staff training pertinent to residents’ needs is included within training and development plans. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 6 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. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1-5 and intended outcomes not assessed on this occasion. EVIDENCE: Key standard 2 was assessed in the previous inspection and a requirement relating to the admission process is carried over and will be assessed next time. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 Further attention needs to be given to ensure care plans are used as an active working document to regularly review residents’ needs and inform staff of current and changing needs, agreed care delivery and reflect actual care given. EVIDENCE: The sample of care plans examined did not reflect an active, pro-active process and lacked a clear direction to staff on agreed and current care delivery. The revised corporate documentation system provided structure for essential information gathering but detracted from a care programme approach. The positive and informative information gathered was not properly utilised within clear action plans. The manager acknowledged that the system did not allow for easy access or flow of clear relevant information for care staff to refer to for appropriate and consistent delivery of care. Each plan included an assessment of needs based on the Activities of Daily Living Model, information gained from the resident about ‘What I expect from the Service’, skills and interests, expectations and aspirations and personal support. However, the plans lacked regular review and continuing evaluation and therefore the content was of questionable relevance to current and changing needs and did not identify whether objectives were being achieved. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 10 The sample did not indicate that a risk assessment approach had been adopted as part of the decision-making within the care planning arrangements and that appropriate risks had been assessed as part of an encouragement to support an independent lifestyle. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11-17 and intended outcomes not assessed on this occasion. EVIDENCE: Key standards were inspected at the previous visit and were found to comply with requirements, with the exception of standard 16. The Manager has indicated that this issue has been addressed and therefore will be assessed next time. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21. There was scope for developing a more person centred holistic approach to care planning, with greater focus on emotional needs and maintaining strengths. EVIDENCE: Records generally showed good monitoring of health needs and appropriate referrals to healthcare professionals were made. Whilst care plan objectives covered personal and healthcare needs, those examined did not reflect emotional needs or the support required to promote or maintain optimum independence or quality of life; providing essential information for care staff to know and understand each individual, particularly those who may be experiencing varying psychological effects from a chronic disease process and how these may impact on well being. Assessments with regard to identifying actual or potential health risks in relation to moving and handling, dependency level; nutrition, continence needs and potential pressure ulcer detection were recorded within the files inspected. However, not all the assessments had been regularly reviewed to identify changing needs. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 13 All of the files sampled held pro-forma statements consenting to the administration of medication by care staff. The pro-forma did not provide adequate assessment information determining considered decisions taken or alternative strategies to care staff assuming control of medication. The care plans identified medication prescribed, however, information relating to the side effects and adverse reactions of medicines being taken by individuals was not readily available. On reflection the home has reviewed the current medication system and is in the process of changing to Boots pharmacy for the provision of solid oral dose prescribed medication in the Monitored Dosage System (MDS) system with a corresponding computer generated Medication Administration Record (MAR) chart to reduce the risk of errors in administration. Medication training for staff will be provided by a Boots pharmacist with regard to appropriate use of the MDS and MAR system, medication policy and improving knowledge of medication taken by the residents and associated side effects and adverse reactions. The care plans sampled were unable to provide evidence of individual consultation or planned arrangements for illness and/or ‘end of life’ choices or preferences with regard to their care. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The home demonstrated a low awareness of the Essex local guidelines and appropriate procedure to be followed in the case of an alleged abuse, which may potentially place a service user at risk. EVIDENCE: Records showed that staff had received training from Leonard Cheshire on issues relating to the protection of vulnerable adults. Since the last inspection, two separate allegations of theft were reported to the CSCI. The allegations were referred back to the home for appropriate investigation to be initiated. The allegations were not upheld, however, the CSCI is still awaiting written confirmation of the outcome of the second from the Leonard Cheshire line manager who facilitated the investigation in the Registered Manager’s absence. This recent situation at the home has highlighted the need for the home to ensure a more robust approach to following local policy guidelines in the event of an allegation of abuse; to ensure a structured strategy is agreed and followed and the appropriate body take the lead in a POVA investigation and to ensure a satisfactory and conclusive outcome. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30. Following extensive building works and refurbishment designed with reference to relevant guidance, Three Forests provides a safe and well maintained environment, furnished and decorated to a very high standard and meets residents’ individual and collective needs in a comfortable and homely way. EVIDENCE: Four additional individual rooms with en-suite shower facilities, built to National Minimum Standards, fully adapted to meet the needs of people with physical disabilities have been registered with CSCI, bringing the number of rooms to nineteen in total. A tour of the premises concluded that recent building work and extensive refurbishment had almost reached the stage of completion and considerable progress had been made in improving individual and communal accommodation for the service users including: • An additional bathroom incorporating a Parker assisted bath with a weight limit of 25 stone. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 16 • The addition of two small lounges will provide additional communal space for residents to receive visitors and guests in private and a quiet area. Each of these lounges will be equipped with facilities for making hot drinks and snacks including a fridge, microwave and kettle. A sluice room incorporating a bedpan washer with a disinfectant and sterilising programme. The en-suite facilities to the existing fifteen rooms have been refurbished to provide wheelchair shower facilities accessible through widened doorways. • • The original larger lounge has a small library; a large wall mounted plasma television, DVD and video player and is used for social activities. The hallways and dining room have been redecorated and refurbished with new carpets and chairs. A final satisfactory Building Regulation Certificate is required upon completion. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The service had not yet achieved an adequate proportion of carers having attained an NVQ qualification in care at level 2 to ensure a competent staff team to support the residents. A thorough and robust recruitment process contributes to the protection of residents. EVIDENCE: Pre inspection documentation indicated that only 39 of the current care staff group had successfully achieved NVQ level 2 in care. Staff recruitment practice was examined by reviewing documentation of recently employed staff and one person recently recruited and soon to commence in post. From the sample examined it was evident the home operated a thorough recruitment procedure based on equal opportunities and ensuring the protection of the residents. The home was currently recruiting additional care and ancillary staff to ensure appropriate numbers of staff to meet the needs of existing residents and the addition of four prospective residents. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 18 Workbooks for inducting new staff had recently been reviewed to incorporate the Skills for Care Common Induction and Foundation Standards within the Leonard Cheshire Induction. The workbooks were well organised and contained all the elements required for a fully comprehensive induction programme. Individual training and development records provided a history of mandatory and specific training initiatives undertaken. It is recommended that annual training plans take into consideration mandatory training update and the development of skills and knowledge in areas pertinent to the residents’ needs and service aims and objectives. Staff awareness and understanding of the psychological stages of loss and grief, particularly relating to the chronic disease process, would benefit residents, with regard to identifying and meeting emotional and psychological needs within person centred planning. Records of formal one to one meetings indicated a need for discussions to have a stronger link to care practice issues and meeting the needs and objectives of the individual residents. Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 43. Resident’s benefit from a well managed service subject to comprehensive quality monitoring. EVIDENCE: Mr Dilep Mahadeo, the Registered Manager, is a General Enrolled Nurse currently on the Register and has successfully completed and achieved NVQ level 4 in Management and Care (The Registered Manager Award). The quality assurance system, including continuous self monitoring, care and operational review and results of resident and representative surveys continues to be well managed and outcomes inform development and improvements to the service and links with the community. The home values and seeks to encourage the diversity of residents and of the community in which it is located. Contacts have been established with the local school to participate in citizenship curriculum, students attend the home to support residents with letter writing. Awareness to four local services has Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 20 resulted in adequate wheelchair access being provided and opportunities regarding joint activities with the police and riding school are being explored. A Three Forests newsletter has been introduced, and will be produced quarterly for the residents, their representatives, stakeholders and the local community. The newsletter is informative and news items or articles of interest are welcomed. There appeared to be clear lines of accountability both within the home and to external management. Reports from representatives for Registered Provider on the conduct of the home are received monthly by the CSCI (Regulation 26). Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 2 4 4 4 X X X 3 Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 22 Yes Are there any outstanding requirements from the last inspection? 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 YA2 Regulation 14 Requirement Timescale for action 01/06/06 2. YA19Y 14,15. The Registered Person must ensure service users are not admitted until a summary of the single Care Management assessment has been received. Service users are admitted only on the basis a full assessment of needs has been carried out to ensure the home is able to meet those needs. Carried over from previous report. The Registered Person must 01/06/06 ensure individual care plans cover all aspects of personal, emotional and healthcare needs, regularly reviewed and evaluated with the service user to reflect appropriate planning and/or changing needs and outcomes achieved. This is a repeat requirement not met within timescales of 1st September 2005. The Registered Person must 01/06/06 ensure individual care plans cover all aspects of personal, emotional and healthcare needs, regularly reviewed and evaluated DS0000017981.V285929.R01.S.doc Version 5.1 3. YA6 14,15 Three Forests Cheshire Home Page 23 with the service user to reflect appropriate planning and/or changing needs and outcomes achieved. This is a repeat requirement not met within timescales of 1st September 2005. 4. YA9 13,14 The Registered Person must 01/06/06 ensure risk is assessed and agreed management strategies for service users to take responsible risks are recorded. The Registered Person must 01/06/06 ensure individual consultation and arrangements for illness and/or ‘end of life’ choices or preferences with regard to their care are planned for and recorded. The Registered Manager must ensure robust procedures and Local guidelines are followed in the circumstances of an alleged abuse. 01/06/06 5. YA21 Schedule 3 (3)(g) 6. YA23 13,21 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 YA35 Good Practice Recommendations The Registered Manager should ensure that training and development are linked to the homes’ service aims and to individual plans particularly with regard to emotional needs. The Registered Person should ensure the minimum of 50 of care staff in the home achieve NVQ level 2 in care. 2 YA32 Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 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 Three Forests Cheshire Home DS0000017981.V285929.R01.S.doc Version 5.1 Page 25 - 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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