Inspection on 27/07/06 for Chadwell House

This inspection was carried out on 27th July 2006.

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

The inspector 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

Chadwell House 31/07/07

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Chadwell House 372 Chadwell Heath Lane Chadwell Heath Romford Essex RM6 4YG Lead Inspector Diane Roberts Key Unannounced Inspection 27th July 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chadwell House Address 372 Chadwell Heath Lane Chadwell Heath Romford Essex RM6 4YG 020 8983 8529 020 8599 3224 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.sanctuary-care.co.uk Sanctuary Care Ltd Ms. Jennie Worthington Care Home 60 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (20) of places Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th April 2006 Brief Description of the Service: Chadwell is a 60 bedded home for older people. This includes 40 beds for people with dementia. The home can offer permanent and respite stays. The home is in Chadwell Heath close to public transport. There are 60 single rooms all with toilet, wash basin and shower. The home is accessible to wheelchair users. There is a garden that residents enjoy sitting in. The home has two floors and is divided into six 10 bedded units. Each unit has a kitchenette, dining area, lounge and bathing facilities. Bathing and toilet facilities are suitable for the needs of older people. There is also a bar area that is used for activities. Activities such as music, outings and bingo are enjoyed by the residents. The current scale of charges is up to £523.98, per week. There are additional costs for items such as hairdressing, chiropody, newspapers and outings etc. Information is made available to prospective service users via a Service Users Guide but this is currently under review. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over nine hours and was carried out as part of the annual inspection programme for this home. The manager was present at the inspection. The Inspection focused upon all of the key standards and the homes response to the last agenda for action. A partial tour of the premises was undertaken. Evidence was also taken from the Pre Inspection Questionnaire completed by the home and submitted to the CSCI. Three residents, three relatives and four staff were spoken to during the inspection. Comment cards were received from three from staff, nine from relatives and eight from residents and/or their representatives, and these were taken into account when writing the report. Due to the care needs of the majority of residents at the home it was not possible to fully obtain their views but residents’ appeared happy, relaxed, comfortable and interacted well with both staff and the inspecting officer. At the current time there are 40 beds (4 units) for people with dementia and 10 beds (1 unit) for older people with general care needs. One unit is currently empty and an application has been submitted to the CSCI to use this unit for people with dementia, raising these numbers to 50. At the current time the home manages the mix of residents well and no issues were raised at the time of the inspection. What the service does well: The manager at the home welcomes inspection and is keen to improve the service provided. The manager has an honest and open approach and wants to address any issues raised. The atmosphere in the home is friendly and people are relaxed. The daily routines of the home are very resident led and change as the resident group changes. Residents spoken to are very happy with the care and services at the home and are very complimentary of the staff team. Relatives are also very happy with the standards of care and state that they felt well informed about any issues and the care of their relative. Relatives feel that the staff team show genuine care and affection for the residents and understand their needs well. Residents, who have come in as emergency/respite placements, have stayed, as they and their families are happy with the placement. The home provides a good standard of care to the Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 6 residents and is keen to improve upon this. Some of the strong points of this home are the staff team, their understanding of the care of people with dementia and the resident activities offered. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. This home no longer provides intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Whilst information is made available, this could be improved and made more user friendly. Prospective residents are properly assessed prior to admission to the home, which ensures the home can meet their current needs. EVIDENCE: The home has a Statement of Purpose in place, which contains all the required information as outlined in the Regulations. However, the context of this document is inappropriate at times, being written for staff at the home rather than for prospective purchasers/customers. Full policies are also in place within this document. This comprehensive document is then used as part of the Service Users Guide. The Statement of Purpose also refers to the home providing intermediate care, which is no longer, the case. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 9 The Service Users Guide is not user friendly. It consists of the Statement of Purpose, a full complaints policy, the inspection report and separate sheets of information regarding staff, terms and conditions etc. etc. Whilst the content of the information is sound, the guide is lengthy and complex. Views of residents and relatives are from compliment cards rather than part of a formal quality assurance system. This documents has not been complied with residents in mind. Both these documents require review. Relatives spoken to confirmed receipt of written information before and at the time of admission, which they felt was helpful. However this may have been with the previous format/owners. The manager and/or team leaders currently undertake all pre-admission assessments. The forms used meet all the requirements under this standard and completed documentation was inspected at random. These were completed to a high standard, giving detailed and individualised information. Records show that the home obtains, where possible, copies of Com 5 – Social Service assessments. This gives the home a good overall assessment and ensures that they can meet the needs of prospective residents. Relatives commented that the staff were very supportive at the time of admission and were able to give them all the information they required. They also confirmed that pre admission assessments had taken place. One relative commented that the person who came to do the assessment treated her relative with a great deal of respect. Those spoken to, came and visited the home before admission and were able to spend time with the manager, who they felt was good at answering any queries they had. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a care planning system in place that is developing positively. Resident’s health care needs are generally met but records need to improve, to evidence this further. The medication systems in the home are managed well. Resident’s privacy and dignity is respected. EVIDENCE: The home has a care planning system in place, which is developing positively with a person centred approach. The system is sectioned into health, physical, social and communication and includes objective sheets, daily notes, risk assessments and signs of wellbeing assessment. Records show that there is evidence of regular reviews and input from relatives on more than one occasion, which is good. The assessment and care plan are recorded as one and resident’s personal preferences/choices are evident throughout although Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 11 this could be develop further as some preferences were noted not to be recorded. The signs of wellbeing assessment is completed monthly and gives a good overall picture of the current state of the residents’ wellbeing. Each resident has a plan of life in place which gives a social history, which includes past employment, family, pets, holidays, places lived etc. These were seen to be very informative but still could contain more detail giving a fuller picture of the resident. This was evident after case tracking residents. Social care plans gave details of resident’s behaviour patterns, what daily tasks they liked to be involved with and to what extent. Care plans were seen to be very informative and focused on the abilities of the residents such as what they were able to do and what they like to participate in and at what level. This covered a wide range of activities. It was good to see objectives recorded but these do require work and possible training for staff as the objectives seen, tended to relate more to the staff rather than to the resident. Good detail was recorded on resident’s behaviour patterns, where appropriate, and these evidenced a good understanding by staff of residents needs. Daily diary notes are recorded and are linked to the care plans. These were seen to be very physically orientated and do not comment on the well being of the resident and how they have actually spent their day. The Manager is already aware of the need to improve these records. Six monthly formal reviews are evident and these are held with social workers if possible. Records show that families are invited and do attend with the resident. Overall the care planning system is satisfactory but some areas do require more work. From records and discussion there is a good individual approach to the care needs of the residents. From discussion with the manager is aware of the shortfalls and is currently working on the person centred approach to care, including activities and life mapping. She is also undertaking coaching for staff, looking at why people with dementia could have behaviour that would challenge staff. They are looking at why this may happen and what may be behind it. The staff also refer to the Dementia Resource Centre next door run by Redbridge and they use them a lot for advice and input. The Manager also commented that the support from within Sanctuary Care is good as staff have backgrounds in caring for people with dementia. Care records show timely interventions and visits from the local GP services. Residents’ weights are monitored regularly but the home does not have a nutritional risk assessment in place. This need was discussed with the manager, especially in relation to the care of people with dementia. Manual Handling risk assessments were seen to be in place along with other appropriate risk assessments relating to the individual resident, such as risk of leaving the building, smoking etc. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 12 Records evidence regular input by the chiropodist and where residents refuse a referral is ultimately made to the local hospital by the GP for an appointment where their needs can be met. A small number of residents were seen to have needs in relation to the condition of their skin. The home needs to ensure that the appropriate risk assessments and subsequent care plans are in place to improve to ensure all their needs are met. In the recent heat wave, residents were seen to have up to date advice and information in their care plan and records show that this subject was also covered at staff meetings. NHS heat wave information was also displayed on the units. Residents and relatives spoken to were very happy with the standards of care provided at the home. Residents said that the staff at the home look after you well and said that they come quickly when you need them and they always have time for you. One relative said that ‘the care is much better here than at the last home as the staff understand mums care needs a lot better’. Another relative said that the manager was proactive in asking them to come to the home to meet to discuss their mother’s care and recent behaviour. Thy added that they had a caring and open discussion and manager gave them some helpful tips and advice on dealing with the situation, which has helped a lot. Relatives felt that the staff try to optimize all the skills that the resident has and build upon them have. One relative said that the staff sit with her mum until she goes to sleep, as she does not like to be alone in a room. Relatives commented that communication from staff at the home was good and that they always felt well informed. Medication systems at the home were checked. The home uses a nomad and bottle to mouth system. No-one at the home is currently self medicating. MAR sheets were seen to be kept in good order, with a checking in system in place. The checking in showed odd shortfalls from prescriptions added on later in the cycle and staff need to ensure that this is addressed in order to provide a full audit cycle. GP’s at the home tend to prompt the medication reviews and these were evident on the MAR sheets. Dates of opening were recorded on liquid medications and a returns system with appropriate records was in place. Controlled medications were checked and found to be kept in good order. Staff need to remember to evidence what has happened to controlled medications in the CD book rather than leaving what appears to be a positive balance. The home is still using Ashley homes policies and procedures in relation to medication and this needs to be addressed. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 13 Residents spoken to, felt that staff respected their dignity and privacy. They said that the staff were polite and always knocked at their doors before they came in the room. Records and discussion with staff showed a respectful and understanding approach to the needs, rights and choices of residents. Relatives spoken to felt that staff had a caring an respectful approach to their relatives and that residents were always well groomed and wore their make up and jewellery if they wished. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Both care and social activities in the home are very resident led and joint working amongst staff could improve this further. Residents have good contact with family and friends. As far as possible, residents are helped to exercise choice and control over their lives. The food provided is generally good and enjoyed by residents. EVIDENCE: The home employs an Activity Officer. Whilst a programme is in place, the activities are very resident led and open to change. This depends on the residents who wish to participate on the day and what they choose to do. Records show what has taken place and these can also inform the care staff in relation to residents’ abilities and choices etc. The records evidence that a range of activities are on offer and they also evidence that residents have had a choice of what to do. Records show that some residents like to attend on a daily basis and also like to access the activity room even when the officer is Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 15 not there. Care staff are able to use this room as well and they know where the equipment is, if required. The manager is promoting that activities are all staff responsibility not just the individual officer. Both residents and relatives comment positively regarding the activities officer and the programme offered by the home. Relatives feel that the activities officer is good at identifying and developing the skills the residents have and in some cases residents are doing things that they have not done for a long while. The home uses a minibus weekly and the residents choose where they would like to go and this includes shopping, cafes, the park and if available local tea dances. The home has links with local churches and residents attend coffee mornings etc. and visa versa. Friends and family are always invited. A few residents few go to day centres where they use to go before admission to the home– by taxi or community transport. The home also has good links with a local school and residents go to plays and school choir comes to the home. The Activities Officer is developing the records, which show residents personal preferences. It would be valuable for these to link in with the social care plans held on each unit and to develop more joint working with the care staff on the units. This would help to ensure that staff know what each other are trying to achieve with residents and what the residents abilities are. From observation, discussions and records, it is clear the routines of the day are resident led as far as possible. Personal preferences are recorded well in many areas of the care planning system. Individual examples of person centred practice were observed, with items particularly put in place to interest and stimulate one resident, in relation to past life, but available to others. The manager is working with staff to get them to understand that residents need to be involved with making tea, breakfast, laying tables dusting etc. The environment is right for this in the small units, with dedicated staff. Records and discussion evidence that activities such as these do take place, to help residents’ independence and self worth, but this could be developed further. Advocacy information is displayed on notice boards. No residents are using an advocate at the moment and the manager report that resources are limited locally. Relatives spoken to always feel welcome at the home and there is an open visiting policy. Relatives also enjoy attending social events at the home. Residents and relatives spoken are currently happy with the food provided at the home. Recent concerns from residents regarding the food have been well logged by the staff, helping them to raise issues. The manager has raised this to good effect, with the catering company. Lunch was observed on three units. Staff were observed sitting and eating with residents on all units and there was a calm/relaxed atmosphere. Menus are displayed on each unit and some units were displaying a pictorial menu. The food looked and smelt appetising. Once a week, the activities officer has some residents to dinner who can self serve in the activities room and this Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 16 proves popular. She also offers this service if there have been issues on a unit and a resident might be looking for a different area to eat quietly. Residents have choice from the menu and whilst this is anticipated the day before, the reality is that residents are able to choose when the meals are served. Care records show residents care needs in relation to diet and personal preferences. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has systems in place to help ensure that concerns and complaints will be listened to and acted upon. The home has systems in place, which help to ensure the protection of vulnerable adults from abuse but training provision needs to be reviewed. EVIDENCE: The home has a satisfactory complaints procedure in place, which is displayed in the main reception area. Consideration should be given to displaying this elsewhere around the home and in different formats for residents. Residents and relatives were clear about who they would raise any concerns with and stated that anything raised is dealt with promptly. Relatives state that the manager is readily available to them should they wish to query anything with her. A complaint logging system is in place and records show that the home logs complaints well, however minor and respond promptly and objectively. The majority of the complaints logged are minor and cover such issues as biscuits, clothes, missing shoes etc. Records show that more substantial complaints are fully investigated and if required a full report is produced. Records also show an objective approach from the management at the home. The manager retains all compliment cards for inspection and these were seen to be very positive with comments such as ‘homely, clean and welcoming’, ‘the Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 18 warmth and enthusiasm of staff’, ‘care staff friendly and welcoming’ and ‘genuine care and staff are interested in my relatives wellbeing’. The current inspection report is available in the main reception area. The home has an up to date adult protection policy in place and from discussion, staff spoken to were aware of adult protection procedures. Staff training records show that there are some gaps staff training on this subject and that some staff have not had an update/refresher for approximately four years. The manager needs to review the provision of this training. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally safe but could be better maintained with regard to décor. The home is clean and hygienic. EVIDENCE: A partial tour of premises was undertaken, but all units were visited. New Christie unit currently has no residents and has been completely redecorated/refurbished to a high standard. There has been a good use of colour in all the rooms and this makes the unit a lot brighter than the others, although the lighting in corridors has not been addressed and this could be improved upon. The manager is awaiting the delivery of new furniture, including beds, for this unit. The home is applying to the Commission to increase the number of dementia-registered beds in the home. As this unit is Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 20 near the road, there are plans in place to fence off a larger garden area, level and replant. There are plans to refurbish the other units in the home and this work is needed as they are beginning to look tired and unkempt. Austin unit is the next unit the proprietors plan to refurbish. Damp areas were noted on the walls in this unit. Furniture around the home was in a satisfactory state of repair and carpets are shampooed as required. One area of the home has an odour issue and this is attended to on a regular basis. Personalised bedroom doors are used on the units for residents who have diagnosed dementia, if they so choose. In many cases it does help residents to accept that they live at the home and find where their personal things are. Photographs and other items on the doors were see to be culturally appropriate for individual residents. Décor in some of the units tends to err towards childlike with posters and murals and whilst this is with good intent, the presentation should be more adult, as residents would have in their own homes. The content is acceptable but the approach is questionable and the staff should review this to ensure it is age appropriate. The home has recently recruited a new handyman for 25 hrs per week. At the current time an agency worker is covering this post. Maintenance records were seen and included hot water temperature checks done. Fire safety certification, tests and drills were seen to be in order. Upon inspection it was noted that hoist on charge blocked a fire exit. This was discussed with the manager on the day. The home was seen to be clean and both residents and relatives commented that this is always the case. The home has infection control policies and procedures in place. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff meets services users needs. Residents are generally in safe hands but the home still does not meet the required standard. The home has generally sound recruitment policies and procedures. The home has a training programme in place, which will helps to ensure that staff are competent to do their jobs but shortfalls were noted in relation to statutory training. EVIDENCE: Recent staffing rotas were inspected at random. The home currently has a few staff vacancies but manages to cover these with their own staff rather than using agency. Staffing levels are currently being maintained at appropriate levels for the care needs of residents and work well linked to individual units, especially as some residents have complex care needs. These levels are usually achieved apart from odd days due to sickness. If required, extra staff will be used to cover escort duties during the day. Sufficient domestic and kitchen staff are employed to cover the home. Relatives spoken to say that the staffing levels in the home have never given them any cause for concern and that staff were always available to talk to if needed. Relatives spoken to say that the staff are 101 and that they cannot Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 22 fault them. They have no concerns regarding the current staffing levels and feel that the staff are competent. Staff were observed, on the day of the inspection, to be visiting residents whilst they were on annual leave from the home. 49 care staff and 16 ancillary staff are employed at the home. Records show that 15 staff have NVQ level 2 and above so the home has yet to achieve the 50 required standard. 7 care staff are currently undertaking NVQ level 2. 22 staff have recently attended training on person centred care and 33 staff have recently attended training in understanding behaviour in dementia care. The majority of staff have also attended training in holistic dementia care. The home has good links with reputable trainers in the care of people with dementia. Records show good levels of compliance with fire safety and infection control training but there are some gaps with manual handling training which need to be addressed. Staff spoken to confirmed recent training in dementia care, fire safety, health and safety etc. and where happy with the level of training and support provided by the management at the home. The home has a staff induction programme linked to TOPPS/Skills for Care. Records show that staff inductions are being completed and staff spoken to confirm this. Apart from the TOPPS induction the home undertakes a smaller one that relates directly to the working of the home. Inductions are led by a Senior Carer in the home. Staff spoken to obviously enjoy working at the home and feel that the environment is pleasant. They feel that the management team at the home are approachable and supportive. Staff enjoy working on the small units and feel that they can meet residents needs well by working with them in this way. The home has recruitment policies and procedures are in place. Staff files were checked at random and were found to be generally in good order with all the required checks and documentation in place. Systems could be tighter with the home evidencing that they have checked out any gaps in employment noted on application forms and that up to date immigration details are in place as some visas were noted to run out shortly. A system for highlighting these is recommended. Probationary records are on file and evidence good levels of supervision for new staff. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is of good character, suitably qualified and fit to run the home. The quality assurance programme in the home is limited and needs to be organised and developed further. Resident’s financial interests are safeguarded. The home has a good staff supervision system in place. Polices and procedures in the home must relate to the new Proprietors. Whilst the health and safety of residents and staff is promoted, some shortfalls were noted. EVIDENCE: Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 24 The Manager has been at the home since it opened. From discussion, she is clearly respected by staff and they know her standards and what she expects from them. Staff say that she is approachable, supportive and a good listener. Records show that the Manager attends training along with her staff. The management team at the home have several resident satisfaction questionnaires in place. Every respite resident is given a satisfaction questionnaire and these were available to be inspected and the results were positive. Every month, Austin unit (op) residents have a satisfaction questionnaire to complete if they so wish and manager feeds back the results to the staff at team meetings. Action plans are also completed if required. No up to date relatives’ satisfaction survey have been done which would be valuable in relation to representing the residents in the home who have dementia. Sanctuary have yet to complete an internal audit at the home. The quality assurance systems in this home need to be developed further. The management team at the home encourages residents or their families to manage personal monies. Where required they will hold small amounts on the residents’ behalf. Systems are in place to record the activity of each account and some of these were checked at random. Records were seen to be in good order with receipts, double signatories and evidence of audit. The home has a good staff supervision system in place. Regular supervision records were seen for all levels of staff and supervision is delegated down through the staff team. The records seen were informative, with only minor inconsistencies. Sanctuary Care has been running the home for a significant time. The home are still using the previous proprietors policies and procedures, in many cases, including key policies such as medication and health and safety. This needs to be addressed. The home does not have a health and safety policy and procedure in place other than that of the previous proprietors. At the time of the inspection there was no formal fire risk assessment for the home but the manager stated that a date for this to be done with the fire officer was booked. Safe working practice risk assessments were in place from the previous proprietor and these need review and transferring to the correct paperwork. COSSH sheets were seen in place and were up to date. Accident records were seen and good are maintained and accompanied by care records, where appropriate. The Manager signs off these forms and reviews any issues that may be outstanding. The home has window restrictors in place throughout the home. Upon inspection staff, in the very hot weather, had overridden these. This had been Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 25 done without a risk assessment being considered. Whilst staff were acting in the interests of residents, they had not given consideration to the risk this may have posed with the primary resident group at the home. Corridors were noted to be very dark in the units, helped in the Christie unit by the redecoration. The management of the home need to review/risk assess this to ensure that the lighting, under health and safety legislation, provides enough lux. Chadwell House DS0000067411.V304943.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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 2 2 Chadwell House DS0000067411.V304943.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. 1 2 Standard OP1 OP1 Regulation 4 and 6. 5 and 6 Requirement The registered person must provide an up to date Statement of Purpose. The registered person must provide a Service Users Guide and include the requirements as listed under Standard 1 of the NMS. The registered person must continue to develop and improve the care planning process in relation to daily records, objectives and life plans. The registered person must promote the health of residents in relation to the use of a nutritional risk assessment, the prevention of pressure sores and treatment of skin conditions. The registered person must ensure the safe handling of medication in relation to hand written prescriptions and the disposal of controlled medications. The registered person must make arrangements to safeguard residents from abuse with reference to staff training. DS0000067411.V304943.R01.S.doc Timescale for action 30/09/06 30/09/06 3 OP7 15 14/10/06 4 OP8 12 30/09/06 5 OP9 13 30/09/06 6 OP18 13 30/09/06 Chadwell House Version 5.2 Page 28 7 OP19 23 8 OP19 23 (4) 9 10 OP33 24 13 (4) OP38 The registered person must keep all parts of the home reasonably decorated. This is a repeat requirement. A decoration programme should be put in place giving timescales. The registered person must provide adequate means of escape in the event of a fire, with reference to a fire exit being obstructed with equipment. The registered person must develop the quality assurance systems at the home further. The registered person must ensure the health and safety of residents and staff in relation to corridor lighting, provision of a fire risk assessment, safe working practice risk assessments and overriding window restrictors. 14/09/06 31/08/06 14/10/06 30/09/06 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 OP1 Good Practice Recommendations The registered person should ensure that the Statement of Purpose and Service Users Guide are presented in an appropriate format, are user friendly and in the correct context. The registered person should continue to develop the social care records and promote joint working between staff at the home in relation to residents’ activities. The registered person should continue to work towards achieving the 50 standard for staff being trained to NVQ 2 level and above. The registered person should record at interview, questions asked in relation to gaps in employment and develop a system for ensuring immigration details are up to date. DS0000067411.V304943.R01.S.doc Version 5.2 Page 29 2 3 4 OP12 OP28 OP29 Chadwell House 5 OP37 The registered person should ensure that the correct polices and procedures are being used in the home. Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chadwell House DS0000067411.V304943.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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