Inspection on 09/01/06 for Chaldon Rise

This inspection was carried out on 9th January 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

Chaldon Rise 06/11/07

Chaldon Rise 14/03/07

Chaldon Rise 20/06/06

Chaldon Rise 13/09/05

Chaldon Rise 15/11/04

Chaldon Rise 15/06/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

1 Marten Road

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

CARE HOMES FOR OLDER PEOPLE Chaldon Rise Rockshaw Road Merstham Surrey RH1 3DE Lead Inspector Kathy Martin Unannounced Inspection 9th January 2006 10:00 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 Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chaldon Rise Address Rockshaw Road Merstham Surrey RH1 3DE 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) 01737 642281 01883 340498 Care Unlimited Mrs Carmelita Paat Shamtally To be confirmed Care Home 34 Category(ies) of Dementia - over 65 years of age (34), Learning registration, with number disability (10), Mental disorder, excluding of places learning disability or dementia (5) Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Up to 10 beds may be used for people with a Learning Disability above the age of 40 years Up to 5 beds may be used for the care of mentally ill residents between ages of 21 and 60 years Up to 2 beds may be used for Respite Care The age/age range of the persons to be accommodated within the category DE(E) is over 65 years. The gender of those accommodated will be: MALE AND FEMALE Date of last inspection 13th September 2005 Brief Description of the Service: Chaldon Rise is one of three homes owned by Care Unlimited, and is a country house, which stands in its own five-acre grounds that surround the home. The house is conveniently situated on the outskirts of Merstham village. The home is registered to offer nursing care for up to 34 older people with Dementia. The home can also care for up to 10 residents with learning disability and 5 with a mental disorder. Accommodation is arranged over three floors accessible by a lift. Bedrooms are mainly single with en-suite toilets and some have bathrooms. Garden spaces are available for residents to go out accompanied. The home offers car-parking facilities for several vehicles. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second CSCI inspection this year. The first inspection took place on the 13th September 2005. This visit was unannounced meaning that the staff, residents and visitors had not been informed it was taking place. All of the key national minimum standards have now been assessed during both visits. The visit started at 10:00 and completed at 12:45pm. The house was clean and tidy and residents were relaxed and comfortable. The residents were observed in their own daily routines or generally resting in the lounge. A few were wandering around the house and had conversations with each other and staff and with the inspector. Many are very physically frail and are not able to freely mobilise due to their illnesses and were observed taking a nap in their chairs. The inspector met the registered manager who was leaving this service in a week’s time to take on another job. The manager was present throughout the inspection and provided information used in this report and assisted the inspector with documentation and also within discussions about the running of the home. The inspector had ample opportunity to meet with residents and staff who also provided information about their working environment. The inspector toured the premises and looked at documentation as part of the inspection. The owner also introduced herself to the inspector and had a discussion about the future inspection processes and general discussion about how the home was operating. The owner is in day-to-day contact and support to the manager was good. In this home many of the residents were not able to communicate verbally due to their Dementia and their responses to questions asked were not always relevant. However the Inspector was able to observe staff practices, their responses to residents’ behaviour and make requirements and recommendations as a result. In general the residents appeared well cared for and were dressed appropriately for the time of year (winter). Staff knew the residents well and were able to care for them in accordance to their written care plans. What the service does well: There is a core staff team who worked well together. There was a good rapport between staff and the manager/ owner, which provided support to each other. There was a friendly atmosphere. The record keeping was good. The home was clean and smelt pleasant. The staff also reported that there was an excellent rapport with residents’ families and visitors. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 6 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. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 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 Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 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): EVIDENCE: This section was assessed during the inspection in September 2005. The comments made then remained current. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 9 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 and 8 Care plans were written clearly. The residents’ needs were met. There was one issue raised regarding the pressure sore management procedures. EVIDENCE: Standard 7: Three care plans were chosen at random and inspected. These were kept in the office under lock and key. Areas of needs were well expressed with good detail demonstrating that staff knew the residents and were able to set reasonable and achievable goals and monitor the care plans regularly. There was good support from relatives and visitors who also provide information about their loved ones especially when residents are unable to express themselves verbally due to their illnesses. Risk assessments were present in the residents’ files for pressure sores, falls and moving and handling. The activities organiser also noted activities, in which residents participated. The residents’ relatives did not currently sign the care plans once discussed with them. This was recommended. Likewise it is recommended that the nurses discussed the use of bedrails with the relatives and asked them to sign a Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 10 consent form that this had been discussed with them highlighting the various risks. Standard 8: All residents are registered with a doctor and also have access to community care professionals such as the chiropodist, doctors from hospitals, dentists and opticians. Records were maintained. One residents’ care was case-tracked to look at the management of pressure sore. A staff member explained that there had been a delay of a week (over the bank holiday period) to obtain a replacement specialist mattress due to malfunction. This had been sent for repair and the replacement that the home kept also had a problem and was not usable. It was not acceptable for a care home providing nursing to incur a delay of a week for a replacement of pressure-relief equipment. It was apparent that the registered nurses needed to communicate more efficiently on their clinical decisions and management of care. 3 different members of staff gave the inspector different versions of the situation evidenced this statement. A requirement was therefore made for the registered persons to make arrangements to ensure continuity of care in pressure sore management of residents to avoid further tissue breakdown. The registered nurses also need to be reminded of their individual accountability regarding residents’ care in accordance with the Nurses and Midwifery Council (NMC) code of conduct. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 11 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): EVIDENCE: This section was assessed in full during the inspection in September 2005. The only change related to the new activities organiser who had recently been employed. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 12 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 The home has procedures in place to assist the residents/ visitors to make a complaint and for the home to address these. The staff are trained to refer any issues under the Safeguarding Adults procedures, formerly the protection of vulnerable adults (POVA) procedures. EVIDENCE: The complaints procedure is accessible to all residents and their relatives from admission. The manager and staff stated that they had a good working relationship with relatives. There were minimal complaints and these were addressed promptly to resolve any issues. The staff received training in Safeguarding Adults and the registered manager was familiar with the procedures and referred appropriately under these procedures before. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 13 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 24 The home was located in a quiet area and had its own large grounds. There are spaces for communal use; which are tastefully decorated. All bedrooms were for single use. There were issues relating to the garden, which would need urgent review and residents’ rights to privacy were also raised. EVIDENCE: This section was assessed during the inspection in September 2005. However during the tour of the building, the inspector raised the following issues: Standard 19: The home boasts a five-acre plot around the house, which is an advantage. However the access to the garden needs to be urgently reviewed. Residents can only go out accompanied due to the various floor levels that they need to negotiate and is therefore not safe to allow them free access outside. There is a low level panel fencing with wiring that separates the garden from the wider plot which is also not adequate and can allow residents to wander further. This would not be safe due to their level of mental frailty and may place them at Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 14 risk of getting lost. This will need to be reviewed and an action plan need to be sent to the CSCI to state how these issues would be addressed without delay to enable residents to gain free access outside. It is acknowledged after conversations with the manager that the owners are aware of this but no concrete plans had been discussed with the CSCI. Standard 24: The bedrooms on the ground floor were kept locked for the exception of one resident who used their own key. This is reported to the inspector as having been discussed with the relatives who are aware of this practice but no evidence was shown (written consent). The reason given was that residents would enter each other’s bedrooms and either removed each other’s possessions and generally interfere with their personal belongings due to their level of Dementia. Therefore bedrooms were kept locked on the ground floor. The inspector did express concerns about this practice and would follow this up with the lead inspector for the service. A requirement was made for the registered persons to review the practice of locking residents’ bedrooms on the ground floor as it restricted their access to their own bedrooms thus possibly denying them their rights to privacy and movement. The inspector also noted that the bedroom doors of the ground floor had glass panels. These panels were covered with a net curtain but did not provide any privacy whatsoever as they were see-through to the outside corridor thus dismissing the residents’ rights to privacy. A requirement was made to completely block these glass panels to provide total privacy. Due to the observations and responses received from staff to argue the practices as described above, a requirement was made to provide the registered nurses with specialist Dementia training to equip them with more knowledge and understanding of Dementia needs. They would therefore be in a better position to lead and supervise their care team appropriately and also rectify poor practices. It was apparent that there was an urgent training need for all staff to understand the rights of residents and also the principles of care of persons with Dementia. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 15 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): 30 This section was assessed during the inspection in September 2005. However under Standard 30 a requirement was made for Dementia training to be provided to reduce poor practice. EVIDENCE: Standard 30: There was a need for the registered nurses to be offered a higher level of specialist training in Dementia to enable them to appropriately supervise and lead the care team to respect all principles of care. Additionally it is still expected of the home to still offer Dementia training for all staff as part of their induction and the on going staff development. More comments on this can be seen under Standard 24. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 16 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 and 38 The management cover has been planned to replace the manager’s hours due to the manager leaving the service. There are procedures in the home to manage health and safety. EVIDENCE: Standard 31: The registered manager is leaving a week following the inspection. The owner confirmed that the assistant manager would cover the manager’s hours. The latter’s hours would then be replaced by increasing the nursing hours. The inspector was advised that advertisements were already out to recruit a new manager. The owner remains in close contact to support the team. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 17 Standard 38: There are a number of policies and procedures to ensure the home ran safely and protected all those living and working there. All staff received training in various aspects of Health and Safety including moving and handling, food safety, First Aid, medication, fire, abuse and risk assessments. The premises are regularly checked for any signs of damage or risk and any issue raised are promptly dealt with. The equipment for nursing, fire and catering is also regularly serviced. Fire records are maintained. The garden needs to be made safe for free access to residents. The garden is currently on various floor levels and residents need to be accompanied to go outside thus restricting movement. A requirement has been made for the registered persons to send a plan to the CSCI demonstrating how they would re-design the garden to make it safe and accessible. The registered persons are recommended to introduce a consent form for next of kin to sign for the use of bedrails. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 18 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 1 X X STAFFING Standard No Score 27 X 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 19 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. Standard 30 Regulation 18 (1) (c) Timescale for action Provide specialist Dementia 17/03/06 training for the registered nurses to better supervise and lead the care team. Make arrangements to ensure 09/01/06 continuity of care in pressure sore management of residents to avoid further tissue breakdown The registered persons are 17/02/06 required to review the practice of locking residents’ bedrooms on the ground floor as it restricted access to their own bedrooms. Block the glass panel doors of 17/02/06 bedrooms on the ground floor, which denied privacy to residents. Send an action plan to the CSCI 17/02/06 to state how the garden would be re-designed to ensure safety and appropriate access to residents. Requirement 2 8 12 (1) (a) 3 24 12 (4) (a) 4 24 12 (4) (a) 5 19 23(1) 23(2) (o) 13(4) Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 38 7 Good Practice Recommendations To introduce a consent form for next of kin to sign to consent to the use of bedrails Residents’ relatives to be asked to sign the care plans when read and discussed with them. Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Chaldon Rise DS0000013307.V278070.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!