CARE HOMES FOR OLDER PEOPLE
Chaltonholme 1-3 First Avenue Westcliff On Sea Essex SS0 8HS Lead Inspector
Michelle Love Unannounced Inspection 1st March 2006 11:00 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 Chaltonholme DS0000015424.V286610.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. Chaltonholme DS0000015424.V286610.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Chaltonholme Address 1-3 First Avenue Westcliff On Sea Essex SS0 8HS 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) 01702 346534 The Southend on Sea Darby & Joan Organisation Ms Lisa Marie Brewerton Care Home 33 Category(ies) of Dementia - over 65 years of age (33), Old age, registration, with number not falling within any other category (33) of places Chaltonholme DS0000015424.V286610.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Home may provide care for two residents under the age of sixty-five years whose names are known to the Commission for Social Care Inspection. 12th October 2005 Date of last inspection Brief Description of the Service: Chaltonholme is a large established home providing 24 hour care and accommodation for up to 33 older people. In addition the home is also registered to admit those people who have a formal diagnosis of dementia. Chaltonholme is owned by the Southend Darby and Joan Organisation. The home is situated in Westcliff on Sea and within close proximity to the local railway station, Southend shopping centre and a range of community facilities. There are 31 single and one shared bedrooms. The premises have been created by joining two main properties. Each floor is serviced by two passenger lifts. There are two communal lounges and one large dining area for residents. There is a large well maintained garden to the rear of the property and car parking facilities to the front of the premises. Chaltonholme DS0000015424.V286610.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection undertaken by Michelle Love, inspector. The inspection lasted approximately 4.5 hours. As part of the inspection process a number of records and documents relating to residents and care staff were examined. Additionally the inspector spoke with both care staff/senior staff and several residents. It was positive to note that following the last inspection only one Statutory Requirement has not been addressed. This requirement has been highlighted within this report. What the service does well: What has improved since the last inspection?
Progress continues to be made with the home’s care planning processes/risk assessments, despite on this occasion one care plan not being devised. Daily care records were very detailed, comprehensive and informative. Issues as highlighted previously relating to omissions on the homes Medication Administration Records, have been rectified except in the case of two entries. The inspector recognises that this is much improved. Much work has been undertaken by the registered provider and manager to ensure that the homes recruitment procedures are robust and in line with regulatory requirements. Of those staff employment records inspected, all records were readily available and in place.
Chaltonholme DS0000015424.V286610.R01.S.doc Version 5.1 Page 6 Rapport between residents and care staff was observed to be positive and it was evident that care staff had a good understanding and awareness of residents needs. The main lounge area next to the office was less crowded with wheelchairs and other equipment. 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. Chaltonholme DS0000015424.V286610.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 Chaltonholme DS0000015424.V286610.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): 3, 4 and 5 The home assesses prospective residents prior to admission. Residents and/or their representatives are given the opportunity to visit the care home as part of the pre admission process. EVIDENCE: Pre Admission Assessments continue to be detailed and comprehensive, depicting individual resident’s needs. In addition to this document a formal dependency profile was completed and information from placing authorities and nursing needs assessments from the local hospital were readily available. Of those assessments inspected, no information was evident in relation to whether or not the resident and/or their representative visited the home prior to admission. The registered manager confirmed that prospective residents and their representatives are invited to visit the home, meet other residents, care staff and look around the care home environment. Chaltonholme DS0000015424.V286610.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, 8 and 9 The home has a clear care planning assessment process within the home, which clearly defines resident’s individual needs. Medication systems within the home ensure that resident’s medication administration, record keeping, policies and procedures are safe and satisfactory. EVIDENCE: On the day of inspection two individual plans of care were examined. It was of concern that the care plan for the newest resident had not been devised. Additionally no risk assessments were available and no formal manual handling assessment had been completed. The resident’s pre admission assessment detailed that the resident had low motivation, mobilises with a walking frame, needed encouragement to feed themselves and a history of falls. Formal assessments relating to pressure sores, nutrition and falls indicated that the resident was at risk-high risk. It was positive to note that daily care records for this resident were very detailed and comprehensive and written after every shift. In contrast the other care plan was fully completed and there was good evidence detailing the specific needs of the individual person. Healthcare
Chaltonholme DS0000015424.V286610.R01.S.doc Version 5.1 Page 10 records were detailed and included information relating to the nature/purpose of the visit by healthcare professionals, any treatment and outcomes. Formal assessments pertaining to manual handling, dependency profiles, falls, pressure sores and nutrition were completed. The home’s medication storage facilities, policies and procedures remain unchanged and appropriate. Only two omissions were noted on the medication administration records whereby records were not signed by care staff to indicate that medication had been administered to and received by residents. Where the dosage states 1 or 2 tablets to be administered, the specific dose administered should be recorded on the medication administration record. Chaltonholme DS0000015424.V286610.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): 12 and 14 A programme of activities is available for residents. Wherever possible, residents’ are helped to exercise choice and independence. EVIDENCE: All staff within the home have a responsibility, for providing and implementing activities for residents’. Documentation evidencing activities undertaken is recorded within individual `social activity plans`. It was disappointing to note that some records had not been updated since December 2005. Wherever possible individual resident’s are encouraged and empowered to exercise choice and maintain independence i.e. choosing where to eat their meals, whether or not they participate in activities, what time they get up in the morning and what time they go to bed etc. Chaltonholme DS0000015424.V286610.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 The home has a clear complaints policy and procedure and complaints received at the home are fully investigated in line with the home’s procedures. EVIDENCE: Since the last inspection the home has received four complaints relating to alleged poor care practices and staff rudeness to individual residents. Details pertaining to the specific nature of the complaint, investigation, outcomes and any action taken were clearly evident. The home’s complaint records were well maintained and organised. In addition to the above, two cards and one letter complimenting the home’s good care practices and care given to residents were readily available. Chaltonholme DS0000015424.V286610.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): 26 The home was clean, tidy and odour free. The homes’ laundry facilities are well organised. EVIDENCE: On the day of inspection the home was observed to be clean, tidy and odour free. No health and safety issues were highlighted at the time of the visit. The home’s laundry facilities are well organised and there is sufficient equipment for the numbers of residents residing at Chaltonholme. Hot water temperatures from residents wash hand basins/showers and baths were seen to be much improved, with only one wash hand basin emitting hot water at 51.1° degrees centigrade. No record of hot water temperatures were available on the day of inspection. The registered manager was advised that as part of good practice procedures these should be monitored on a regular basis. Chaltonholme DS0000015424.V286610.R01.S.doc Version 5.1 Page 14 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, 29 and 30 Staffing levels within the home remain appropriate for the numbers and needs of residents. The homes robust recruitment procedures protect residents. The home continues to be committed to providing appropriate training for all members of staff. EVIDENCE: At the time of the inspection there were 26 residents residing at the care home. As a result of the numbers of residents, the registered manager has reduced staffing levels accordingly with a view to increasing levels as soon as the numbers of residents increase. The staff rosters indicate that some staff are working long days/double shifts as a result of covering current staff shortages. The registered manager advised that a `recruitment drive` is currently underway. The staff rosters indicate that all staff are having appropriate days off. Since the last inspection, two new members of staff have been recruited. It was positive to note that all recruitment records as required by regulation had been sought. Records of induction (instruction and competency) were readily available. It was evident that the home’s training matrix for some staff had not been updated therefore it was unclear as to what training had been provided and undertaken since the last inspection. The registered manager and deputy manager advised that training undertaken since the last inspection includes
Chaltonholme DS0000015424.V286610.R01.S.doc Version 5.1 Page 15 vital signs, adult abuse, first aid, basic food hygiene, COSHH (control of substances hazardous to health), managing incontinence, pressure area care and blood glucose monitoring diabetes. From inspection of training records for one of the newest members of staff, it was evident that not all mandatory training had been undertaken i.e. manual handling, health and safety, infection control and fire safety. Chaltonholme DS0000015424.V286610.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): 33, 35, 36 and 38 Resident’s monies are safeguarded by the home, however it is unclear as to whether or not residents have an individual account or monies are pooled. Staff are appropriately supervised. Records as required by regulation promote resident’s health and safety. Regulation 26 visits are conducted by the registered person. EVIDENCE: The inspector was advised that no individual monies are held at the care home for residents. All residents have access to a £100 `float` per week or extra as and when required. Every 3-6 months a statement of monies spent/monies available is forwarded to the care home for all residents. Records indicate that all staff working at the care home receive formal staff supervision at least once three monthly. In addition to staff supervision all staff are expected to attend monthly staff meetings.
Chaltonholme DS0000015424.V286610.R01.S.doc Version 5.1 Page 17 A representative from the board of trustees, visits the home to conduct Regulation 26 visits. No reports have been forwarded to the Commission for Social Care Inspection since October 2005. This is not in line with regulatory requirements and must be reviewed for the future. A random sample of records as required by regulation were examined. Records relating to fire drills, fire alarms, electrical and gas safety installation certificates, passenger lift/hoist and sling certificates were all seen to be satisfactory. No records were available pertaining to the homes emergency lighting. COSHH risk assessments/data sheets were readily available. Chaltonholme DS0000015424.V286610.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 3 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 3 X 3 Chaltonholme DS0000015424.V286610.R01.S.doc Version 5.1 Page 19 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 OP7 Regulation 15(1) Requirement The registered person must ensure that a comprehensive and detailed care plan is devised for all residents residing at the care home. The registered person must ensure that risk assessments are devised for all areas of identified risk. The registered person must ensure that where the dosage states 1 or 2, the specific dose must be recorded on the MAR sheet. The registered person must ensure that all staff receive mandatory training and that the homes training matrix is kept up to date. The registered person must ensure that Regulation 26 visits cover all elements required within this regulation and a report is forwarded to the Commission once monthly. (Previous timescale of 1.12.05 not met) Timescale for action 01/06/06 2. OP7 13(4) 01/06/06 3. OP9 13(2) 01/06/06 4. OP30 18(1)(c) 01/09/06 5. OP33 26 01/06/06 Chaltonholme DS0000015424.V286610.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. Refer to Standard OP5 Good Practice Recommendations Ensure that information relating to whether or not residents and/or their representatives visited the care home prior to admission is recorded as part of the pre admission processes. Ensure that formal assessments i.e. Manual Handling are completed for all residents. Ensure that records depict activities undertaken by residents and these are updated on a regular basis. As part of good practice procedures, ensure that hot water temperatures from residents wash hand basins, showers and baths are regularly recorded. 50 of all care staff should attain NVQ Level 2. Ensure that records are available relating to the homes emergency lighting. The registered manager should achieve NVQ Level 4. 2. 3. 4. OP8 OP12 OP26 5. 6. 7. OP28 OP38 OP31 Chaltonholme DS0000015424.V286610.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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