Inspection on 26/06/07 for Chadderton Total Care Unit Limited

This inspection was carried out on 26th June 2007.

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

Chadderton Total Care Unit... 23/06/09

Chadderton Total Care Unit... 27/02/07

Chadderton Total Care Unit... 27/09/05

Chadderton Total Care Unit... 03/05/05

Chadderton Total Care Unit... 20/10/04

Chadderton Total Care Unit... 21/04/04

Chadderton Total Care Unit... 19/11/03

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Chadderton Total Care Unit Limited Middlewood Court, Middleton Road Chadderton Oldham Lancashire OL9 9SR Lead Inspector Mrs Fiona Bryan Unannounced Inspection 26th June 2007 09:00 X10029.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 Chadderton Total Care Unit Limited DS0000025429.V343448.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 and 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. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chadderton Total Care Unit Limited Address Middlewood Court, Middleton Road Chadderton Oldham Lancashire OL9 9SR 0161 627 0027 0161 628 7769 mary@total-care.org.uk 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) Chadderton Total Care Unit Limited Mrs Mary Alison Green Care Home 151 Category(ies) of Dementia (45), Old age, not falling within any registration, with number other category (70), Physical disability (40), of places Physical disability over 65 years of age (70) Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. One Registered Mental Nurse to be on duty on Saddleworth unit throughout each 24 hour period. Two Registered Nurses to be on duty between 8am and 9pm and one Registered Nurse to be on duty between 9pm and 8am on Chadderton Unit. Three Registered Nurses to be on duty between 8am and 9pm, two Registered Nurses to be on duty between 9pm and 8am on Lakeland and Middlewood Unit. Manager to be supernumerary to the above. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 151 service users to include:*up to 45 service users in the category of DE(Dementia under 65 years of age).*up to 70 service users in the category of OP (old age, not failing within any other category).*up to 40 service users in the category of PD (Physical disability under the age of 65 years of age).*up to 70 service users in the category of PD(E)Physical disability over 65 years of age). 27th February 2007 Date of last inspection Brief Description of the Service: Chadderton Total Care provides care and accommodation for 151 residents with a variety of needs. It is divided into four distinct suites, including care for older people with dementia (Saddleworth Suite), general nursing (Lakeland and Middlewood Suites) and a suite for younger adults with disabilities (Chadderton Suite). The suites are staffed separately with qualified staff who have the knowledge and skills to provide the appropriate care for each service user category. The home has its own physiotherapy unit and is able to offer exercise and therapy to those who require it. The home is owned by Chadderton Total Care Unit Limited, which is a private company, and is managed on a day-to-day basis by a registered manager who is also a nurse. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 5 Accommodation is provided on the ground floor throughout the home. Fortyfour rooms are single en-suite, whilst a further 86 rooms are single and are furnished with a washbasin. Five double rooms are also available for couples or those who wish to share. One unit is temporarily not being used until it has been upgraded and this will then provide a further 12 single rooms. The home has several courtyard areas accessible for wheelchair users and a pleasant garden with seating at the back of the building. The lounge/dining spaces are open plan and provide ample space for movement by wheelchair users. Disabled facilities are also provided. Fees for accommodation and care at the home range from £449.26 to £720 per week, depending on the degree of nursing care needed. Additional charges are also made for hairdressing, newspapers and personal toiletries. A service user guide is on display in the reception area of the home. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included a visit to the home. The manager and staff at the home did not know this visit was going to take place. This is called an unannounced inspection. One inspector and one manager spent time at the home looking around parts of the building, checking the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. We also spent a good deal of time on the Saddleworth Unit looking to see if the care to the people living on this unit had improved since our last visit. In order to obtain as much information as possible about how well the manager and staff looked after the people living there, we spoke to service users, staff, and visitors. Before the inspection, comment cards were sent out to residents and relatives/carers asking what they thought about the care at the home. Information from these has also been used in the report. We sent the manager a form before the inspection for her to complete and tell us what she thought they did well, and what they need to improve on. We feel she completed this honestly and we agree with what she wrote. She told us what plans she has in place to address the weaknesses identified in the service. We could tell that some of the key standards that we had been satisfied the home was meeting at the last inspection were still being met, from the information we got from residents, relatives and the manager before the site visit. What the service does well: The home has lots of space and residents can move around freely and enjoy friendships with each other, regardless of the unit they live on. This applies to all but the Saddleworth Unit, which owing to the dementia of the residents who live there, has restricted access in and out of the unit. Many of the residents join in with a wide range of social events and activities and they were mostly complimentary about the home and the staff who cared for them. Comments included: “Everyone is very friendly”. “The home is big and it is kept very clean”. “The washing is done for you and the home is kept clean”. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 7 “There is always someone to call if you are not well”. “A beautiful, clean home”. “Wonderful caring staff”. “I am more than pleased with ----’s care. If there is anything wrong, no matter how small, staff tell me as soon as I arrive. If I’m not visiting that day they call me at home”. “The home looks after my mum and all the residents very well and are very caring. My mum is settled and likes it”. “Reception and cleaning staff do a superb job”. “Management do an exceptional job”. A comprehensive training programme is in place and provided to all staff. Observations of staff on the Saddleworth Unit showed them to be gentle, and caring. Staff were respectful of residents, yet enjoyed friendly banter with them. What has improved since the last inspection? What they could do better: Staff on the Saddleworth Unit need to make sure they fully use the large amount of space provided so that residents are not seated in one area all day. The manager needs to consider how to increase the provision of privacy for people using the toilet (from the lounge) on the Saddleworth unit. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 8 As we got some mixed comments regarding the provision of food, the manager should gather further information from residents about what they think of the food and how they would like it to be improved. Staff in charge of units should ensure they remain “on the floor” to offer supervision and direction to staff, particularly those whose practice is not consistent with the others. The manager and staff on the Saddleworth Unit need to have in place some strategies that promote the rights of all residents, including those who staff may find difficult to manage, so that they respond to all residents at each time of asking and do not ignore anyone. 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 be made available in other formats on request. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3 for older people and standard 2 for adults 18-65 Quality in this outcome area is good. Improvements in the assessment process ensure that all residents’ needs are identified before they come into the home which means the manager is confident that staff can meet those needs. This judgement has been made using available evidence, including a visit to this service. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 11 EVIDENCE: In information supplied to the CSCI before this site visit the manager confirmed that all new or prospective residents are visited either at home or in hospital. This ensures that any relevant information is gathered about the person’s needs before a decision is made as to whether the home can provide the care required. Three people were case tracked. Care management plans from the local authority are still not kept together with the home’s own assessments but the home’s pre-printed care plans, which are used on admission to continue the assessment process, were completed in better detail. The manager was also able to demonstrate that regular audits of the documentation are now taking place with the aim of continuing to improve the quality of information contained in the records. Risk assessments for pressure areas, falls and moving and handling had been completed on admission and, since the last inspection, nutritional risk assessments are also undertaken and bed rail risk assessments are carried out where indicated. Staff were knowledgeable about people’s care needs and preferred routines and residents said that staff knew what help they needed and what their preferred routines were. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 for older people and standards 6, 9, 16, 18, 19 and 20 for adults 18-65 Quality in this outcome area is good. Residents’ health and personal care needs were being well met by staff who knew the residents’ preferred routines and how best to support them in their lifestyles. This judgement has been made using available evidence, including a visit to this service. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 13 EVIDENCE: Three people were case tracked and the care files of several other residents were looked at in relation to their specific care needs. Records in general across all the units had improved since the last inspection and provided better information about the support and care that was needed. Since the last inspection the manager has implemented an audit system so that the standard of documentation can be regularly reviewed and steps taken to improve it where necessary. Records of the audits undertaken so far showed that the staff had identified care plans that were not very personalised. All staff that are involved in writing the care plans and the unit managers have been given feedback about any shortfalls to ensure that they are developed further before they are next reviewed. Care plans and risk assessments had been reviewed monthly and it was evident from at least one care file that the increased and more thorough monitoring and interventions that had been put in place to address care needs had resulted in an improvement to the resident’s condition. As stated in the last section, bed rail risk assessments and nutritional risk assessments had been carried out since the last inspection and appropriate action had been taken where risks were identified. Since the last inspection all residents had been weighed and most were weighed monthly unless there was a specific reason not to do so or the resident refused this. Where care plans showed that staff needed to monitor the behavioural changes to residents, records concerning this had improved. Care plans for agitation were explicit in offering staff advice on how to manage the resident but were still somewhat generic. When reviewing these care plans, staff could use the records of behaviour that they have completed to personalise the care plan further by stating if triggers to agitation have been identified and what parts of the care plan are most effective. Residents were seen to be dressed appropriately with socks, stockings, shoes, slippers and clean clothes, and staff were proactive in observing and acting when people needed help with personal care. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 14 It was noted on the Saddleworth unit that staff were supportive of residents and assisted them with aspects of personal care in a gentle manner. They were mindful of respecting privacy and staff were observed to remind or prompt residents if their clothing was not as it should be. However, privacy for residents using the toilet from the lounge area was compromised, as it was possible to see into this toilet when staff open the door, which, at times, they needed to if they had to get additional clothing. This was not reflective of staff practice, but was due to the design of the lounge and toilet area. Care practice on the Saddleworth Unit had much improved since the last visit, and staff were observed for some time. Staff demonstrated they knew how best to approach people and when to give people some space. This was confirmed in all their dealings, with the exception of one carer. Since the inspection the manager of the home has confirmed the action taken to address this. A small number of medicine records were examined during this site visit and these were satisfactory. Again, since the last inspection, the manager has set up an audit system to regularly review medicine records and stock levels to ensure that staff are following the home’s policies and procedures correctly. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 for older people and standards 12, 13, 15 and 17 for adults 18-65 Quality in this outcome area is good. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle but further development is still needed for people living on Saddleworth and other residents with more diverse needs to ensure that their quality of life is as enriching as possible. This judgement has been made using available evidence, including a visit to this service. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 16 EVIDENCE: To gather information about what other people thought of the service, surveys were sent to residents and relatives before this site visit. Residents were asked to make comments about what was good about the home. The following comments were made: “We have plenty of parties”. “We go out on day trips”. “I play dominoes twice a week”. “We have a Christmas party”. “We have a BBQ in the summer”. “We get plenty of entertainment”. “The social therapist has provided me with wool and needles as I like kitting”. “It’s very nice at Christmas – six schools come and sing carols”. “We play bingo twice a week”. “There is a church service every week”. “There is a therapy class five times per week”. During the site visit a group of residents told the inspector about the social events and activities that were arranged for them. They said there was “plenty going on” – fairs and parties. They had recently been to Holmefirth and enjoyed fish and chips, and were going to the Lowry Centre the following day. A library of videos and CD’s was available in the therapy room and several residents said they made use of this and borrowed items to use in their own rooms. Residents said that a trip out had been arranged for each week in August. All of the above information confirmed what was seen at the last inspection; that people living in the rest of the home, other than Saddleworth, were mainly satisfied with the social activities and stimulation provided for them. However, at the last inspection there were concerns that residents living on Saddleworth did not enjoy the same access to social interaction and mental stimulation. Since the last inspection an alternative therapist has been employed to undertake work with residents on Saddleworth on a one-to-one basis. It was reported that the key worker system was being expanded and staff were starting to put together life histories with residents to gain a better insight and understanding about their past experiences and interests. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 17 However, a relative who returned a survey on behalf of a resident living on Saddleworth commented that entertainment on the unit seemed to centre mainly on the television, which none of the residents appeared to engage in. Since the last inspection they had seen a “party of the month” advertised on posters at the entrance to the unit but no details had been verbally communicated to them when they visited. The manager acknowledged that social and mental stimulation for people living on Saddleworth was still an area that needed development. On the day of the site visit “old tyme” music was being played and residents were encouraged to dance with each other or staff. This was seen to be popular, particularly for some of the ladies. Other activities were also taking place on a one-to-one basis, for example, one member of staff spent time chatting to a resident and a member of staff read the newspaper with another resident. Two residents had “dolls” and the use of “doll therapy” was discussed with the manager. The provision of such dolls in this instance was clearly beneficial to the residents concerned, as they were seen to be very animated and happy. This unit was seen to be lively at times with activity, but it was not chaotic or noisy. The group of residents spoken to on the day of the site visit said that the quality of food was mixed. All agreed that there was a choice but said that sometimes the food was cold. One of the staff members said that she felt the meals for people requiring soft diets could be improved, as they lacked variety and some of the residents got bored with what was offered. Since the last inspection extra staff have been employed to assist at mealtimes on Saddleworth. This has allowed staff to focus on ensuring that residents are eating properly and has resulted in a more structured approach to making sure that residents enjoy their dining experience. Extra snacks between meals are offered to the residents to ensure that they receive an adequate calorie intake over the course of the day. This was seen to be particularly prevalent on the Saddleworth Unit. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 for older people and standards 22 and 23 for adults 18-65 Quality in this outcome area is good. Increased staff awareness and knowledge regarding procedures for safeguarding adults means that residents in the home are protected from abuse. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Residents who were spoken to said that if they had any complaints they would speak with the manager and were confident any issues would be taken seriously and dealt with properly. Staff said that since the last inspection the procedures to follow in respect of safeguarding adults had been discussed with them again to ensure that they were all aware of the correct actions to take. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 19 Incident records showed that there had been several occasions when residents had been aggressive towards other residents. Records confirmed that these instances had been reported to the respective residents’ care managers and appropriate discussions had taken place with GP’s and referrals made, where necessary, to other health care professionals. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 for older people, and 24 and 30 for adults 18-65. Quality in this outcome area is good. The environment overall presents as being well maintained, spacious and comfortable for people living here. This judgement has been made using available evidence, including a visit to this service. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home provides a spacious and reasonably well-maintained environment. The home is single storey and allows for free movement by people around the home to all areas, with the exception being people living on the Saddleworth Unit. Bedrooms looked at and communal spaces were clean and well presented. People living here can bring their own furniture and possessions with them and it was evident that a good number had chosen to do so. People were seen to freely access all areas, including the gardens. The use of plants and good natural light in most areas created a good environment. Some areas, however, were darker owing to restricted natural light, although artificial lighting is prevalent in such areas (such as the unit for younger adults). The Saddleworth Unit is not freely accessible, with entry provided through fingerprint recognition. The use of this was restricted to staff. This unit provides care for older people with dementia and is relatively new. The design is such that the lounge area is central with bedrooms, bathrooms and toilets coming off this area. The unit is spacious and whilst sufficient natural lighting is provided through windows in the roof, the provision of windows that people can see out of is limited. Only one patio window in the dining room is available for people to look out of. On the day of the inspection, whilst we were told that staff made good use of the space for people, this was not particularly evident. Most, if not all, the people living on the unit were seated in the lounge area and seemed to be very much kept together. This gave a feeling of being “closed in”. The space provided on this unit should be utilised to better effect on an everyday basis. The design of the toilets off the lounge give rise to privacy and dignity issues, as it is possible to see into the toilet from the position of some of the chairs in the lounge. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30 for older people and standards 32, 33 and 35 for adults 18-65 Quality in this outcome area is good. The home was adequately staffed to ensure the needs of the residents were being met, with a comprehensive training programme in place to support staff in delivering care in a consistent manner. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: At the last inspection no issues were raised about staffing levels within the home, other than on Saddleworth. Since then, extra staff have been employed to ensure that there are enough staff on Saddleworth to meet people’s needs. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 23 Within the rest of the home most people were generally happy with the levels of staff on duty, although some said that they had to wait on occasions when they asked for attention. Residents, in the main, felt that staff understood their care needs and had the necessary skills to do the job. Some staff in particular seemed very well liked by residents and were praised for how hard they worked. However, several residents did comment that not all staff were as caring as they could be and a relative returning a questionnaire said that some staff lacked empathy. One resident said that staff were, in the majority, very helpful and courteous but some were “anything but”. Staff observations on the Saddleworth unit showed that, overall, staff were very caring and knowledgeable about the way in which to care for people. All staff responded to residents by sitting next to them when they were talking and lots of friendly chat between residents and staff showed a mutual liking for one another. It was noted that one carer on three occasions demonstrated poor practice and, on most occasions, one resident’s behaviour was ignored by staff, when he was shouting out for attention and swearing at staff and other residents. The nurse in charge of the unit was not present for most of the inspection and was therefore not on hand to ensure these matters were dealt with. These issues were raised with the manager of the home at the end of the inspection and the manager has confirmed the action taken to address this. The home has a comprehensive training programme that includes training regarding the principles of care and communication. In information provided before the site visit, the manager said that she wanted to develop a system to assess the impact of such training on staff to ensure that the theoretical knowledge they received was translated into good care practices. In view of some of the feedback about staff attitude, this approach would be helpful in determining where staff had further training needs. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 37 and 38 for older people and standards 37, 39, 40 and 42 for adults 18-65 Quality in this outcome area is good. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 25 The management of the home has greatly improved the systems/procedures and accountability within the home, which has been reflected in improved outcomes for residents with regard to the quality of care they are now receiving. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The manager is an experienced nurse who has managed this home in excess of ten years. She is supported in the role by two deputies, who work shifts to ensure that at least one of the management team is on duty during the day. Both deputies are longstanding members of staff and, from discussion, knew their roles well in supporting the manager, but also in supervision of staff and undertaking and delivering training to staff. At the last inspection robust arrangements were in place to give residents the opportunity to air their views about the home and make comments and suggestions for future development. This practice continues and minutes of meetings with residents and staff were seen to support this. Since the last inspection, the manager and deputy managers regularly review a selection of records within the home, such as care files and medicine records, to ensure that staff are following the home’s policies and procedures correctly and improving the areas where there were shortfalls. It is to the manager’s credit that the issues highlighted at the last inspection have been acknowledged and taken seriously. Good progress has been made in taking steps to address those areas identified as weak and the manager has been open in her assessment of the progress made to date and has a plan in place to effect further improvements. This openness and honesty shows the manager has good insight into the areas that need to be improved. Several residents who need to be moved by hoist confirmed at this site visit that staff consistently used the hoist and did not move them without it. The use of the hoist was observed, as were the use of wheelchairs fitted with appropriate footplates. Throughout all the moving and handling techniques observed, only one episode of poor practice was observed. This was raised with the manager and appropriate action taken. Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 26 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 x 2 x 3 3 4 x 5 x 6 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 ENVIRONMENT Standard No Score 19 3 20 x 21 x 22 x 23 x 24 x 25 x 26 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 x 33 3 34 x 35 x 36 x 37 3 38 2 Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 28 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 2 3 Refer to Standard OP10 OP19 OP15 Good Practice Recommendations The registered person should consider ways of screening the toilet on the Saddleworth Unit so that the privacy of people using it is increased. The staff on the Saddleworth Unit need to make sure they fully utilise daily the good abundance of space on the unit for the benefit of the service users. The manager needs to be mindful that some people spoken to feel the food could be improved, and she should speak to residents further about this and what they would like to see improved. Staff left in charge of the units need to make sure that are “on the floor” with staff, thereby ensuring they are able to identify poor practice and address it. The manager and staff on the Saddleworth Unit need to have in place some strategies which promote the rights of all residents including those who staff may find difficult so that they respond to all residents at each time of asking, and do not ignore anyone. 4 5 OP36 OP30 Chadderton Total Care Unit Limited DS0000025429.V343448.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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. 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