Inspection on 27/02/07 for Chadderton Total Care Unit Limited

This inspection was carried out on 27th February 2007.

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 but made no statutory requirements on the home.

Other inspections for this house

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

Chadderton Total Care Unit... 26/06/07

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 27 February 2007 09.20 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.V300324.R02.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.V300324.R02.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.V300324.R02.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 8 a.m. & 9 p.m. and 1 Registered Nurse to be on duty between 9 p.m. & 8 a.m. on Chadderton Unit. 3 Registered Nurses to be on duty between 8 a.m. & 9 p.m., 2 Registered Nurses to be on duty between 9 p.m. & 8 a.m. 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 September 2005 Date of last inspection Brief Description of the Service: Chadderton Total Care provides care and accommodation for 151 residents users 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.V300324.R02.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.V300324.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by two inspectors and included a site visit, which took place over two days on 27th February and 6th March 2007. Time was spent talking to residents, relatives and staff and observing the home’s routine and staff interaction with residents. Nine residents were looked at in detail, looking at their experience of the home from their admission to the present day. A partial tour of the building was conducted and a selection of staff and residents’ records was examined including records of care, medication records, employment and training records and staff duty rotas. Since the last inspection a new unit has opened to care for up to 30 residents with dementia. The original unit for people with dementia has closed and will reopen following refurbishment at a later date. What the service does well: The manager sets a high priority on making sure that staff get enough training to do their job well and staff said that they felt well supported in their work. 50 of care staff are trained to at least NVQ level 2, and the home has been one of the first to put forward three carers for a new type of training (Trainee Assistant Practitioners) that will give them skills over and above the level of NVQ’s. The manager is also proactive and forward thinking about staff recruitment, taking on new staff in advance when she is given notice that others are leaving so that staffing levels remain constant and residents receive consistent care from people they know. Residents living on the Lakeland, Middlewood and Chadderton suites were positive about living at the home, saying that the food was usually good and there were social events and activities that they could join in with if they wished. Routines seemed reasonably flexible so residents had some choice about how and where to spend their day. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 7 The arrangements for handling residents’ money were good, allowing residents to manage their own money if they wished to do so and were able to. This promotes residents’ independence. The home is generally clean, pleasant and comfortable and is well maintained by a team of on-site maintenance workers. Residents spoken to liked their rooms and one resident said his room was “nice and big” and he spent a lot of time relaxing in it. What has improved since the last inspection? What they could do better: Record keeping needs to be improved on all the units. Assessments did not always contain enough information about the care residents needed. This means that the home cannot always be sure and could not demonstrate that they are aware of the needs of people before they are admitted. Information from assessments had not always been transferred to the care plans which prevents staff from having consistent information about how to care for people. Staff must be more thorough and accurate in reviewing residents’ care to make sure that they seek advice from other health care professionals when it is indicated. This will allow other professionals to be involved in the care of residents, and ensure they receive appropriate treatment to maintain their good health. Some procedures in medicine recording must be stricter to avoid possible mistakes being made when residents are given medicines. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 8 Although residents on the other units were satisfied with the arrangements for social activities more thought is needed as to how residents on Saddleworth suite receive social and mental stimulation. The manager must make sure that all staff in the home know the action they must take if they suspect abuse of any kind. Lack of clarity about the procedures to be followed was evident and the home had not involved the appropriate people following an incident that occurred, to ensure that the correct action was taken to protect the residents. This lack of clarity has resulted in someone not being kept safe. A lot more thought must be given as to how the environment on Saddleworth can be adapted to help staff deliver better care for residents with dementia, for example, by using techniques to help orientate residents and by creating quieter areas for residents who wish to sit quietly or need to spend time away from other residents. The manager needs to develop a system to audit records and care practice within the home to ensure it meets the required standards. 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.V300324.R02.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.V300324.R02.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 adequate. Failure to identify all residents’ needs during the assessment process may lead to a risk that some needs will not be properly met. This judgement was made using available evidence, including a visit to this service. EVIDENCE: Nine residents’ files were examined and cross-referenced in full. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 11 Details were obtained by the home before each resident’s admission but in many cases some information was missing. Care management plans from the local authority were not kept together with the home’s own assessments and care plans and were not used as a working document. On admission preprinted care plans were used to continue the assessment process but in many cases they were not fully completed with details about residents’ care needs in respect of their nails, teeth and hair, dislikes/likes, preferred bed time and rising times or how often they needed pressure relief at night, etc. Some residents’ more diverse needs, for example, their cultural needs were not always considered or described. Some care needs that were identified did not have a corresponding plan of care. This is discussed in more detail in the next section. A member of staff had visited the last resident to be admitted to the home, before admission but this is still not usual practice, although it was recommended at the last inspection, in order to allow both staff and resident the opportunity to get a better idea of the care the resident requires and the services the home can offer. Risk assessments for pressure areas, falls and moving and handling were generally completed on admission but there was no recognised system for nutritional risk assessments in place. The manager said that some staff had recently attended training about the MUST tool but this had not yet been implemented at the home, although this would be implemented. Residents spoken to did feel that generally staff knew their preferred daily routines and the main areas that they needed help with, and staff were able to describe these and appeared to know the residents well, however some of their knowledge was not actually written down anywhere so may not be widely known to all staff. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.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 poor. Systems for monitoring the healthcare needs of residents are not consistent. This means that residents’ personal, health care or social needs may not be met. Some practices in respect of medicines’ records put residents at risk. Residents generally felt that staff treated them with respect. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 13 This judgement was made using available evidence, including a visit to this service. EVIDENCE: On the day of inspection nine care plans and other documents recording the support provided to residents were examined and cross-referenced. It was noted that a number of those on Saddleworth Unit had not been dated and so it was difficult to assess when they had commenced. Records in general across all the units provided little information about the support being provided to residents, and some care needs that were identified during the assessment process were not addressed through care plans at all, for example, one resident had a medical condition that caused a lot of pain but there was no plan as to how this would be managed and monitored. Records maintained by the home need to be improved so that information about support and care provided is available and should include details of dietary intake, information about emotional or behavioural support provided and details of any other professional input. Care plans were signed as reviewed, however, on occasion it was clear that the actual needs of the residents had not been considered during the review process. Due to this instructions were not always updated and rewritten to reflect changes in needs such as, on return from hospital, the management of behavioural changes, nutritional state or to reiterate instructions provided by other health and social care professionals. Records, reports and other correspondence confirmed that routine health care is readily available in the home and includes dental checks, opticians, podiatrists, and physiotherapy. The home also provides its own part time physiotherapist. Most residents had received a flu vaccination. All residents have blood pressure checks and routine urinalysis at least once a year and there was evidence that their GP’s had been requested to undertake an annual review of their medications. A clear record of the care provided to those with feeding tubes was maintained and the conscientious care for one resident who had been admitted with pressure sores had been successful in healing them. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 14 Staff need to be aware of their responsibilities in relation to following the home’s guidelines and policies. For example, service users with bedrails had not been risk assessed and a corresponding care plan put in place, even though examination of the home’s policy and procedure concerning restraint gave clear instructions about the home’s responsibility for risk assessing, gaining permission and developing and reviewing a care plan in relation to bedrails. Staff need to demonstrate better diligence and professional knowledge in respect of interpreting and monitoring all aspects of the health needs of service users. For example, it was noted on the first day of the site visit that a resident had lost a significant amount of weight, however no steps had been taken to investigate and remedy this situation. When the nurse in charge was asked whether the resident had been referred to the dietician, she said they had not as they ate well and had a good appetite. The nurse did not see it as a cause for concern that despite eating well the resident was still losing weight. Following initial feedback from the inspectors that day, by the second day of the site visit all the residents on one unit had been weighed and several more were found to have lost weight. Steps had been taken to increase the calorie intake for these residents by introducing snacks between meals, etc., and they had been referred to the dietician. It was noted that residents across all the units were not routinely weighed every month and, in some cases, when they were weighed, the weights recorded varied between metric and imperial measurements, making it difficult for staff to compare and ascertain if a resident’s weight was stable. When staff were asked why residents were not weighed more frequently, they said that each resident’s care plan was reviewed monthly and if there was any reason to suspect that a resident might be losing weight, for example, if they had been ill or had a poor appetite the previous month, arrangements would be made to weigh them more often. However, there was evidence that staff were not reviewing care plans as thoroughly as they should, as one care plan had not been relevant for over a year but was still being signed and dated each month by staff as having being reviewed and ongoing. In addition, a request had been made for staff to monitor the behaviour of a resident; however the records made did not include even basic information required such as the time and place of the behaviour or the intervention provided by staff or the outcome for the resident. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 15 Steps need to be taken to ensure that personal care is provided to a good standard, as on the day of inspection, a significant number of residents on Saddleworth Unit were not fully dressed and wearing tights, socks, or stockings. The manager said that this was not normal practice and on the second day of the site visit residents were suitably dressed. Furthermore, although personal care was attended to, the interaction between staff and service users was, in the main, functional and tasks completed impersonally. For example, staff were observed feeding two residents at the same time, which did not allow for personal one-to-one attention, and staff were, at times, dismissive of residents, telling them to “go and sit down” when they were following them around the unit, instead of trying to find a possible cause of their being unsettled and addressing it. One resident spent some time lying on the floor and staff just stepped over them saying that this was what they always did. Medication had been received into the home without being correctly entered onto the medication record sheet and hand written entries had not been signed, or the amount of medication received recorded. Furthermore, one written entry had been scribbled out and the dose increased, yet it was not possible to identify the date, who had altered the prescription or who had authorised this change; therefore it was unclear if the resident concerned had been receiving the correct dose of medication. Residents seemed, in the main, to like the carers and felt they were treated well. One resident on the unit for younger adults said he got on fine with the carers and they treated him with respect. Staff were observed to be interacting positively with several residents on Lakeland and residents again said they were usually treated well, although one resident said he thought staff were sometimes “a bit casual” and the younger ones did not know how to relate to older people. He gave an example where he could not sleep and asked for help to get comfortable and had been asked by the carer “well, what do you want me to do about it?” which he had found quite offhand. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 16 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 adequate. The home shows a strong commitment to providing opportunities for residents for social stimulation and interaction but needs to further consider how this can be achieved for residents with diverse needs and those on Saddleworth. Visitors are encouraged and welcomed into the home and routines are flexible to provide residents with some choice about their daily routines. The dietary needs for most residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 17 This judgement was made using available evidence, including a visit to this service. EVIDENCE: The home employs three activity therapists, and a wide range of activities and social events had been offered to residents since the last inspection, including trips out to Holmfirth, Salford Quays, Blackpool, Oswaldtwistle Mill and the Bridgewater Hall. Special days such as St Patrick’s and St George’s Day, Halloween and Valentine’s Day had been celebrated and parties had been held on each of the units. On both days of the site visit, residents were observed taking part in therapy sessions and several residents were having their hair washed and set. There was little recognition or description of individual residents’ interests and hobbies in their care plans and this is an area that could be improved. Care plans mainly just stated that the resident attended the therapy sessions and/or the religious services, but were not particularly person-centred. However, residents on Lakeland and the unit for younger adults said that they were generally satisfied with the types of activities provided by the home. Activities and opportunities for social stimulation for residents on Saddleworth were less satisfactory. One relative thought that the resident they visited was “kept clean” but there was “not enough going on”. On the first day of the site visit no noticeable activity was observed taking place with residents, who were milling about, with the television on in the background but no-one watching. The nurse on Saddleworth said that the activity therapists came to the unit twice a week but spent more time with residents on a one-to-one basis, as it was difficult to manage large groups of residents and the environment did not offer anywhere to take small groups. It was reported that two of the residents went to the unit for younger adults to participate in the therapy sessions there. The manager said that two of the therapists had undertaken training in providing activities specifically for people with dementia and events such as fish and chip suppers have been arranged on the unit. Information about the social background, interests and preferences of residents on Saddleworth was inconsistent. Some care files contained detailed information, others less. The manager said that the families of all the residents on Saddleworth had been asked to complete a social profile but not all of them had been returned. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 18 Development of a key worker system may help to further identify residents’ individual social needs, particularly for those residents that are most dependent and those with diverse cultural needs. Residents said that they were able to get up and go to bed as they wished and were able to choose how and where to spend their time. Visitors said they were made welcome. Residents spoken to said that in the main they liked the food provided by the home and were given a choice at each mealtime. Examination of the menus showed that a variety of food was provided. All the residents said they could have a cooked breakfast if they wished. Lunch on the first day of the site visit was cheese on toast, which looked very nice with plenty of cheese. Tomato soup, ham salad or ham sandwiches were also on offer with yoghurts, tinned and fresh fruit (bananas, apples and grapes), jelly and fairy cakes available for dessert. A number of residents did say that they had to wait for a long time for meals to be served after being asked to sit at, or being taken to the dining tables. Service users requiring maximum support were provided with a soft diet, however it was observed that one member of staff fed two service users at the same time. The manager said that she was recruiting meal service assistants for lunch and teatimes on the unit to ensure that the carers had enough time to help and supervise all the residents who needed extra assistance. Following initial feedback from the inspectors on the first day of the site visit, by the second day extra snacks mid morning had been introduced for residents as it had been identified that several residents had lost weight. The home must now continue to demonstrate that adequate steps are taken to make sure that all service users received a good quantity of nutritious and wholesome food. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 19 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 poor. The home has a satisfactory complaints system with some evidence that residents and their representatives’ views are listened to and considered. Referral procedures within the home need to be reviewed and adhered to ensure that all residents are kept safe. This judgement was made using available evidence, including a visit to this service. EVIDENCE: The home has a complaints policy and keeps a record of any complaints that are made, together with details of how they are investigated and any action that is taken to address the complaint. This showed that complaints were taken seriously and dealt with properly. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 20 Residents said that if they had a complaint they would speak to one of the nurses or the unit manager and felt confident that any problems would be sorted out. Most staff spoken to were familiar with the complaints procedure and said that they would refer any serious complaints to the manager. On the first day of the site visit, records showed that an incident had occurred that was not managed appropriately. The inspectors requested that the incident was reported to the adult protection team that day and on the second day of the site visit it was reported that the relevant agencies had been to the home and appropriate action had been taken to protect the residents. A number of the nurses said they had not yet undertaken training in safe guarding adults and one nurse was very vague about what the policies and procedures were. The manager said that all new employees received this training and that a rolling programme was in place to ensure that all staff had the training. Most staff said that they would report any suspected abuse to the manager. Following discussion about the incident highlighted above, the manager and deputy managers said they were clearer about the action that should have been taken and felt it had been a learning event. Residents on Lakeland and Chadderton units were able to identify someone on the staff team that they would report any concerns to and said they felt safe and secure in the home. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 21 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, 22 and 26 for older people and standards 24 and 30 for adults 1865 Quality in this outcome area is good. The home is well-maintained and provides a safe place for residents to live. More thought needs to be given to developing the environment on Saddleworth to ensure it is conducive to providing good dementia care. This judgement was made using available evidence, including a visit to this service. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 22 EVIDENCE: Since the last inspection ongoing refurbishment and replacement of equipment and furniture has taken place. The manager provided details of equipment purchased, which included items such as reclining chairs, profiling beds, hoists, specialist pressure mattresses and cushions and hoist scales. Many areas of the home had been redecorated including the lounge and hallways on the unit for younger adults, the lounge areas on the Lakeland Suite and a number of residents’ bedrooms. One bathroom has been upgraded and converted into a shower room and another bathroom has had a new specialist bath installed and has been retiled. New carpets have been fitted in 18 rooms throughout the home and 32 bedrooms on the unit for younger adults and Middlewood unit have been provided with new furniture. The central part of the building has been re-roofed. Three maintenance staff work at the home for a total of 120 hours per week. Residents’ rooms in all the units except Saddleworth were personalised and homely. Residents had photographs, ornaments and items of their own furniture and said they liked their rooms. One resident said the home was “always clean and fresh”. A number were looking forward to being able to go out in the grounds in the better weather. Residents said the home was well kept and one resident said, “the Christmas decorations were lovely”. Some of the rooms on Saddleworth were personalised but many appeared quite bare and impersonal. Although the rooms were clean and tidy they had a “corporate feel” with little evidence of the resident’s own personality and interests. More thought needs to be given to the environment on Saddleworth and how it affects the residents living there. The unit appeared to be chaotic and noisy and there was a lack of separate space for residents who wish to sit quietly. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 23 The communal areas have no windows so the only natural daylight comes from skylights, which the residents cannot see out of. Several residents were heard to ask what the weather was like outside, and although the unit has air conditioning it felt hot and stuffy as there was no ventilation and fresh air. Guidelines for providing a good environment for people with dementia, such as signposting, should be considered and implemented to help the residents engage with their physical and social surroundings. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 24 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, 29 and 30 for older people and standards 32, 34 and 35 for adults 18-65 Quality in this outcome area is good. Consideration is given to the dependency of the residents and the requirements of the service to be delivered, to ensure that staff are available in sufficient numbers for continuity of care to be provided. The home’s recruitment procedures protect the residents. The home meets the standard for the percentage of care staff who have completed NVQs and an ongoing training programme is in place, which ensures staff have the skills and knowledge to care for the residents. This judgement was made using available evidence, including a visit to this service. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 25 EVIDENCE: Staff and residents on all the units except Saddlewood said that there were generally enough staff on duty. Staff duty rotas showed that the home maintained reasonable staffing levels for the numbers of residents in occupancy. Two nurses on Lakeland were due to leave employment at the home in the near future and two new nurses had already been recruited and commenced employment to ensure that there was a sufficient handover period and that the new nurses had a full induction before the two staff that were experienced in the home left. This is very good practice as it ensures the smooth running of the home and minimises any disruption to the residents or inconsistency of care. The dependency of many of the residents on Saddleworth was high and it was acknowledged by the staff working on the unit and the manager that more staff were needed to meet the residents’ needs. Again, the manager had been proactive in recruiting three more carers to work on the unit and was looking at shift patterns for them to ensure that extra carers were on duty at the busiest times of the day. Three staff personnel files were examined. All contained three references, one being from their last employer and all contained evidence that the relevant checks about their suitability to work in a care home had been made. 50 of care staff have attained at least NVQ level 2 and the home is committed to supporting staff to undertake this training. In addition three carers are currently Trainee Assistant Practitioners and attending training via the PCT to extend their skills and knowledge over and above the level of NVQ. Inspection of the training file confirmed that the induction package for new employees meets the Skills for Care common induction standards. Evidence was provided of a range of training for different staff including training in enteral feeding, the recognition of abuse, management of pressure areas, nutritional support, skin care and bandaging, infection control and basic food hygiene. Staff said that regular training days took place and several were engaged in a training afternoon regarding male catheterisation on the first day of the site visit. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 26 Residents had confidence in the nurses to care for them properly but one did say that they thought some of the younger carers did not always know how to communicate with older people and thought junior staff were not always very well trained in this area. Other residents said staff were “very good” and “I am looked after very well”. Mandatory training in health and safety topics runs as an ongoing programme. It was noted that no-one had undertaken specific training in first aid. If nurses are designated as first aiders they should ensure that they have up to date knowledge about current first aid and resuscitation techniques. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 27 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, 35, 37 and 38 for older people and standards 37, 39 and 42 for adults 18-65 Quality in this outcome area is adequate. The home has a quality assurance system in place, which provides opportunities for residents and relatives to offer their views about the home. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 28 Residents’ financial interests are safeguarded. Record keeping needs to be improved to ensure the continuity of care and protection of service users. The health and safety arrangements in place ensure that residents live in a safe environment. This judgement was made using available evidence, including a visit to this service. EVIDENCE: The manager is registered with the CSCI and there are clear lines of accountability within the home. Resident satisfaction surveys are sent to 20 of residents or their representatives every two months. The results are analysed and published in the service user guide. The most recently published analysis was November 2006 as the manager was in the process of analysing the surveys that were returned in January 2007. Feedback in November 2006 had been generally positive and the manager said that where comments or suggestions were made, if possible, it would be discussed with the resident to agree any action needed by the home. Residents can reply anonymously if they wish so in those cases the manager can only respond in a general way. Some of the comments made by residents included “the staff are hard working and they treat the residents as if they were their parents or grand parents”, “the staff are very hard working – they do not seem to have any spare time” and “the atmosphere is friendly and relaxed”. It was reported that residents and staff meetings are held regularly, although the minutes could not be found on all units. Records were available of staff meetings held on 28/3/06 and 29/9/06, residents meetings on the younger adults unit on 10/1/06 and 21/2/07 and other resident meetings on 2/2/06 and 30/10/06. The registered provider has undertaken regulation 26 visits and meets with residents and staff every two months to give them the opportunity to speak with him directly and offer their views of the home. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 29 Staff said that the manager and deputy managers were approachable and supportive. A monthly meeting with unit managers is held and used to cascade information to all grades of staff. The home achieved the Investors In People award in 2006 for the fourth time over a nine year period. Procedures for handling residents’ money were satisfactory and promoted residents’ rights to manage their own money if they wished. Residents can deposit money in their account or withdraw up to £20 per day via staff on the reception desk. Amounts larger than £20 need to be ordered the day before. All transactions are recorded in triplicate and the accounts are held electronically and audited regularly. Although some aspects of the home are good, especially the arrangements for staff training, maintenance of the environment and social activities and food provision for units other than Saddleworth, the poor standard of record keeping and health care monitoring means that residents’ health and welfare has at times been compromised. The manager should develop a system to audit care and medication records to ensure they are maintained to the required standard. Health and safety records were available, which showed that the maintenance of the building and equipment was up to date. Staff receive refresher training in health and safety topics such as fire safety and moving and handling. One resident did say that staff did not always use the hoist and this was discussed with the manager who said she would speak with the staff concerned. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 30 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 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 2 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 4 36 X 37 2 38 3 Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement The registered person must ensure they are in receipt of an assessment for all residents so that the home is confident they can meet those needs and no one is admitted whose needs cannot be met. The registered person must ensure that care plans (using assessment information) are accurate, dated and detail the action which needs to be taken to meet all aspects of residents health, personal and social care needs. (Timescale of 30/11/05 not met). The registered person must ensure that advice and treatment from other healthcare professionals is obtained, thereby promoting their continued good health. The registered person must ensure that appropriate risk assessments are undertaken for all residents to identify risks to their health and safety and where risks are identified action must be taken to reduce them. DS0000025429.V300324.R02.S.doc Timescale for action 30/04/07 2 OP7 15 30/04/07 3 OP7 13,15 30/04/07 4 OP8 13 30/04/07 Chadderton Total Care Unit Limited Version 5.2 Page 32 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. 5 Standard OP9 Regulation 13 Requirement The registered person must ensure that all medicines are recorded on receipt into the home and must ensure that handwritten instructions are validated and countersigned by a second member of staff. Changes to the dosage of medicines must be clearly dated and countersigned. This will ensure that staff are clear on the dosage to be given. The registered person must make sure that the adult protection policy is implemented for all allegations of abuse, and staff must receive sufficient training in this area to allow them to do this appropriately, and to ensure that all residents remain safe. Timescale for action 30/04/07 6 OP18 13 30/06/07 Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 33 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 OP5 Good Practice Recommendations The registered person should ensure that all prospective residents are visited by a member of staff at their address prior to admission to ensure that they have the opportunity for appropriate consultation and to be informed of what the home is like. The registered person should ensure that systems are in place and adhered to, promoting residents’ personal care and appearance to an acceptable standard, daily. The registered person should consider the development of the key worker system to maximise person centred care and assist in meeting residents’ diverse needs. The registered person should review the food and service provision at mealtimes on Saddleworth to ensure that it meets the needs of all the residents. The registered person should consider environmental adaptations on Saddleworth to reflect current best practice guidelines in dementia care settings. The registered person should ensure that a system of audit is set up to ensure that accurate records are maintained. The registered person should ensure that where registered nurses are designated as the home’s first aiders they have up to date knowledge about first aid and resuscitation techniques. 2 3 4 5 6 7 OP8 OP12 OP15 OP22 OP33 OP38 Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashton-under-Lyne Area Office 11th Floor, West Point 501 Chester Road Old Trafford 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. Chadderton Total Care Unit Limited DS0000025429.V300324.R02.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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