Inspection on 04/07/07 for Chamber Mount

This inspection was carried out on 4th July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chamber Mount 01/12/05

Chamber Mount 07/11/05

Chamber Mount 18/07/05

Chamber Mount 19/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Chamber Mount 197 Chamber Road Werneth Oldham Lancashire OL8 4DJ Lead Inspector Michelle Haller Unannounced Inspection 4th July 2007 08:50 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 Chamber Mount DS0000060625.V339699.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. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chamber Mount Address 197 Chamber Road Werneth Oldham Lancashire OL8 4DJ 0161 665 3185 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) Elizabeth Knight Anthony Knight Barbara Meredith Care Home 23 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (23) of places Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 23 service users to include: * up to 23 service users in the category of OP (Older people not falling within any other category). *up to 6 service users in the category of DE(E) (Dementia over 65 years of age). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 1st December 2005 2. Date of last inspection Brief Description of the Service: Chamber Mount is a residential home providing 24-hour personal care and accommodation for up to 23 service users over the age of 65 years. The home is situated approximately one mile from Oldham’s town centre and is close to local shops and amenities. Bus services are available close by providing access to Oldham town centre or Manchester city centre. Chamber Mount has a small flagged area to the rear and gardens to the front and side of the property. The home was originally two Victorian houses that have been converted to one, and the front faces onto Chamber Road. A ramp has been installed at the side entrance to the home providing level access. Bedroom accommodation is provided on three levels including lower ground floor, ground floor and first floor. A passenger lift and a chair lift are available for the use of service users. Chamber Mount provides nine single bedrooms and six twin rooms. Bedrooms are pleasantly decorated with complementary curtains and bedding. Bathing facilities include one assisted bath, one unassisted bath and two shower rooms. There is a choice of lounge and dining areas all of which provide comfortable well-furnished accommodation. The home charges £313.88 per week. The Commission For Social Care Inspection report is on display at the entrance of the home. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 5 Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included an unannounced site visit to the home. The manager of the home was not informed beforehand of the visit. The inspection process involved interviews with four service users, two members of staff, the manager and one of the registered providers. The method for storing files meant that it was possible to read through the majority of assessments and care plans. The Annual Quality Assurance Assessment (AQAA) had been completed and returned and other documents concerning the running of the home were also examined. Seven completed service users and relatives Commission for Social Care Inspection (CSCI) surveys had also been completed and returned. These provided valuable information and many of the quotations in the report were come from these. A tour of the private and communal areas of the home was undertaken and during the course of the day the interactions between staff and service users was observed. What the service does well: The manager ensures that people are made welcome and provided with a clean and warm environment. Assessments and care plans are completed to a high standard and provide staff with clear and detailed information about meeting the needs of service users. People receive good quality personal and health-care, and feel they are well looked after. Meals and drinks provided at Chamber Mount are of good quality, plentiful and nourishing and enjoyed by those living there. In the main people living in the home are content. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 7 Action is taken to promote the wellbeing, safety and independence of service users. The staff are well trained and a high standard of personal and health care is achieved. The home provides people with the opportunity to comment on the quality of the service. All people spoken to were complimentary about staff, food and the running of the home. Statements were, in the main, positive and included: ‘I like it I have no complaints.’ And ‘I am happy living at Chamber Mount. I have no complaints all. I feel most of my needs are covered by the home.’ What has improved since the last inspection? What they could do better: The manager needs to make sure that the ratio of staff employed in the home is sufficient to meet all the needs people at all times, particularly in respect of providing meaningful activities and spending time speaking to people. The manager also needs to be able to demonstrate that there are mechanisms in place that allow people to feel that they are listened to at all times, and in all circumstances. This may increase their general contentment with living at Chamber Mount, and demonstrate that people are seen as individuals, and their views and interests are valued and given due consideration. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 9 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 Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 is not applicable). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager at Chamber Mount ensures that people are provided with enough information to make a decision about moving into the home and that a detailed assessment of needs is completed prior to admission. EVIDENCE: Each file examined contained a pre-admission assessment, completed prior to the date of admission and a detailed assessment completed very soon after admission. The assessments included all aspects of physical and emotional wellbeing. Risk and other specialist assessments such as pressure care or falls prevention were also on file. People and/or their representative had signed the assessments. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 11 Records demonstrated that needs were also re-assessed following any significant changes in the condition or situation of people. Discussions with people and information in the surveys returned confirmed that the manager had ensured that staff could meet the needs of people. All the seven surveys returned indicated that the respondents felt that they had been provided with sufficient information about Chamber Mount. Statements included: ‘Mum came for 2 weeks respite, she was so comfortable and settled here she decided to stay!’; and ‘I don’t remember but I’m told someone came to see me while I was in hospital.’ Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 12 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. 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. People at Chamber Mount have their health and personal needs met based on their assessment with the principles of respect, dignity and privacy fully put into practice. EVIDENCE: The care files that were examined contained care plans that provided detailed information and instructions to staff about the support needs of each person. These plans reflected the needs identified in the assessments, were clearly written, easy to follow and made it simple to monitor progress. The care plans and additional records verified that people received routine health checks such as opticians, podiatrist and dental care regularly. In addition specialist health care advice was obtained as the need arose. Reports Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 13 indicated that staff continue to escort people to hospital appointments when required. People said: ‘If I feel poorly they get help right away.’ Furthermore those who returned surveys felt that their health needs were always fully met, and no negative comments were made about the health care provided. Daily records further confirmed that staff provided support as stipulated in the care plans. The manner and tone in which reports were written demonstrated that staff were respectful of the people and cared about their wellbeing. Reports also indicated that staff took steps to make sure that people remained happy and comfortable, alerting senior staff about any concerns they may have. Records and notes confirmed that people with specialist health care were effectively managed. For example people with diabetes received the correct treatment including medication and diet, the result of blood sugar monitoring confirmed that this was effective. Additional observations and care to reduce the health risks associated with diabetes including skin care, optical checks and foot care was also implemented. On the day of inspection people were well groomed and all had been supported in achieving a good level of personal care. Checks confirmed that people were wearing their own clothes. And the laundry process continues to ensure that clothes were presentable and returned to the correct person. Staff were observed interacting with people in a gentle and respectful manner, and, in the main, giving each person individual attention and listening to their responses. Comments about staff attitude included: ‘Staff listen to you if you need anything.’ ‘Staff are very good.’ and ‘never come across anyone rough.’ In the main people felt that they were adequately informed about the progress of their relative, one person felt that, in the past, this had not been the case. The medication policy was examined and this provided clear instructions to staff. Medication is stored in a locked cupboard. The medication record sheets were examined and no errors were noted on this occasion. The manner in which medication was distributed was observed and this appeared satisfactory in that, the person administering medication made sure that it was taken before moving on to the next person. Pictures had been placed on the medication administration record sheets (MARS) to assist with identification. The manager stated that the majority of staff have completed a medication awareness course and certificates confirmed that this training had been provided via Oldham Metropolitan Borough Council (OMBC) mid 2006. The medication file also contained a copy of the CSCI pharmacy guidelines and the manager confirmed that the homes policy was in keeping with these. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 14 Staff who were interviewed are able to describe the way in which they worked to ensure privacy and dignity, including using privacy screens when required, ensuring that bathroom and toilet doors were locked and explaining and talking to people quietly when dealing with issues of a personal nature. Staff observed during the inspection were thoughtful and respectful in their approach. Comments from staff included ‘We must know each resident and know how to take care of them in a certain way,’ People and their relatives were complimentary about the conduct of staff and statements included: ‘Staff always pleasant and treat mum with respect and preserve her dignity while at the same time having fun.’ Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 15 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. 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. The aim of the manager at Chamber Mount is to enable people to make choices about their lifestyle, and, in the main cultural and dietary needs are well met, however the social, educational and recreational activities provided should be revised as, they do not meet the needs of a significant number of people. EVIDENCE: The assessments included information about peoples interests, however this was not always used in planning recreational support. There was little evidence that daily activities were provided by the home as on previous occasions and a number of people commented that they would like more games such as bingo, quizzes, dominoes, armchair aerobics, crafts Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 16 entertainers and other activities. People said: ‘There’s not enough to do- there are magazines and newspapers to read.’ ‘Sometimes feel we could do more- it varies.’ and ‘We are aware of time limitations of staff…but more activities would help to motivate and pass time more constructively’. Some people did confirm that they had enjoyed the quizzes, bingo and the karaoke, however, these events were not often enough. A record of activities had been maintained and this indicated that the main activities for the past few weeks had been watching television and ‘social interaction’. The manager and those living in the home confirmed, however, that religious services also took place and people were supported in accessing the community by using the local ‘ring and ride’ bus service. The manager confirmed that she was aware that activities had tailed off in the home, and that she would speak to people and staff about ways of improving individual and group activities so that people remain stimulated, and their emotional and psychological wellbeing is promoted. The registered provider also also stressed that she was commited to improving the social activities and as evidence confirmed that a member of staff had completed specialist training in order to develop skills in this area. During the inspection service users were observed reading the latest newspaper and books, including talk books, are provided by the library service. People confirmed that there were no problems with visiting the home and visitors always felt welcomed. Comments included: ‘my family can come when they like.’ and ‘I go to see my mother 2 or 3 times a week.’ People stated that the running of the home was flexible and they were able to make choices about what they did: ‘I don’t feel the need to sit here all day-I can go to my room when I like.’ And ‘I get up when I’m ready- usually around the same time, and I go to bed when ready.’ The menu was examined and considered to provide a good variety of traditional British food; it was clear from discussion with people that they felt able to order what they wanted. On the day of inspection the lunchtime meal was lamb chops and mint sauce, minted potatoes carrots and Swedes. This meal looked very appetising and people enjoyed it. One lady who appeared very frail, was at times quite confused, took a long time to speak and needed support to eat, whispered: ‘It’s nice’ whilst she was eating. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 17 Other comments about food at Chamber Mount included: ‘Food is good and we get plenty.’ ‘The food’s very nice and we get what we like- we eat a lot.’ I really enjoy the food. I always eat all my meals.’ Meals are very good. Good at all times. Given a choice daily.’ And from a relative, ‘my………is no longer a 6 stone weakling!’ The larder, fridge and freezer were well stocked with an extensive variety of quality brand products and ingredients. Charts confirmed that people are weighed at least once a month and action taken to try and support them in maintaining a healthy weight if a significant and sustained change is noted. The support provided to people during meals had improved, there was now a detailed food and drink intake chart kept for the frailest people and it was observed that there were sufficient staff on duty to provide one to support. In general terms people were satisfied with the lifestyle they have at Chamber Mount comments included: ‘I am happy living at Chamber Mount- I have no complaints at all. I feel most of my needs are covered by the home.’ ‘It’s great.’ ‘Staff have a very caring and affectionate relationship with the residents.’ And ‘staff are great I have been in the home for…..and they have really looked after me.’ Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The rights and wellbeing of people at Chamber Mount promoted as they are informed about the complaints procedure and robust adult protection training and guidelines are in place. EVIDENCE: The complaints procedure was examined and gives good information to people about how to make a complaint or comment about the home. A copy of this and a complaints form had been placed in each bedroom. No one interviewed or who returned surveys said that they had made a complaint, however each was confident that they could speak to the manager or care staff if they had any complaints or concerns. The majority of people asserted that they felt listened to and all were aware of the complaints procedure. Statements included ‘If any complaint would be dealt with we are aware of the formal complaints procedure.’ ‘If any problems I would speak to the manager or deputy.’ And ‘I would talk to the deputy.’ Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 19 There were no formal complaints recorded by the manager during the past year. Certificates confirmed that a significant number of staff have recently received updated adult protection training, and supervision notes confirmed that POVA was discussed as part of the core values of working at Chamber Mount. Those who were interviewed were clear about behaviours and actions that were abusive and how to prevent and report abuse. Comments included, ‘I would go to the manager if I was worried. They are quite willing to listen to you. ’ One relative felt that staff were diligent enough to recognise there might be a problem, even for someone with communication difficulties and stated: ‘…doesn’t verbalise well, fortunately staff know her well and would be aware if things weren’t right.’ The home also operates a protected disclosure or ‘whistle blowing’ policy and t that, the manager stated, that this is highlighted during the induction of new staff. It was reported that no POVA accusations or investigations had occurred in the home since the previous inspection. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 20 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. 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 physical design and layout of Chamber Mount promotes the safety and independence of people in the home. EVIDENCE: A tour of the home was undertaken. All the communal areas were clean and fresh. There was no domestic worker on duty during this inspection. The majority of bedrooms were clean and free from unpleasant odours. People had been able to personalise their rooms with their own furniture, ornaments and pictures. The rooms are tastefully decorated and homely. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 21 The furniture and fittings in the home were clean, free from stains and pleasant to use. The lounge areas were homely and warm. It was noted that the dining furniture had been replaced. The manager continues with the refurbishment program and all rooms will eventually be redecorated and carpets replaced. People were observed using handrails and ramps as they moved around the home. Staff were observed using moving and handling equipment correctly. The bathrooms, toilets and shower areas were clean, warm and easy to access. Comments included, ‘Cleanliness was one of the reasons for choosing the home.’ And ‘I really like my room, it’s just been done up.’ Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager understands the need to ensure that people benefit from skilled staff, who are available in sufficient numbers to provide good care and enable the smooth running of the home. EVIDENCE: On the day of inspection there were 21 people living at Chamber Mount and there were two care-staff plus the manager on duty. This is a lower staff ratio than is generally available and the duty roster indicated that there is usually one additional carer, a cook and cleaner. The owners also take an active role in providing support and care. Observations and discussion with staff demonstrated that this ratio does not fully meet the care and social needs. Discussion with the registered person, and the information in risk assessments and care plans confirmed that 20 people required either physical or verbal prompts to complete all personal care tasks and, three people needed two carers to assist with mobility. At lunchtime it was noted that three people required physical assistance to eat and others required verbal prompts. Staff also needed to complete the medicine round, other care duties and domestic tasks. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 23 People who returned surveys felt that staff were usually available- as one person commented- ‘depending on the work load’ to meet their needs. ‘ It was noted over the course of the inspection that the care staff were very hard working. Staff ratios were discussed with the manager and registered provider; they confirmed their commitment to employing more staff so that there were three carers and the manager on shift at the busiest times. Staff files were examined confirmed that staff vetting had improved and files contained POVA first and criminal record checks and two references. Contracts do not stipulate the hours staff are to work, however the roster now has a more predictable shift pattern. Certificates confirmed that staff received appropriate training. There is a rolling programme of training and in the past year this has included moving and handling, nutritional support management; smoking cessation, and induction into care, first aid, dementia care level 2, challenging behaviour, identifying abuse, health and safety, food hygiene, fire safety and NVQ levels 2 and 3. The domestic staff also completed NVQ 2 in cooking and catering. Staff were in the main complimentary about the support provided by the registered manager and although feeling pressured due to the pressure of work. However one identified that the best thing about Chamber Mount was ‘Everyone is made welcome- it’s like a second home and everyone gets on.’ Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by, a manager who is fit to be in charge. The manager gives those involved an opportunity to comment about the service and is willing to listen, however there is a strong suggestion that this ethos is compromised by the wider management team. EVIDENCE: Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 25 The manager has achieved NVQ level 4 in long term care and continues to update and increase her knowledge and skills by attending training courses, and has completed the Trainer and Assessors city and guilds award, this will help her to provide effective training to staff. The home has links with Oldham Social service training partnership and new staff have access to the Skills for Care Common Induction course. Letters and other correspondence, and comments from staff verified that the manager provided a good level of effective supervision and valued training. The quality assurance questionnaires were read through and this demonstrated that people including social workers and district nurses were generally satisfied with the running of the home. Comments received in the CSCI surveys indicated that at times people did not feel listened to, mainly due to staff being busy. The analysis of the quality assurance was examined and this highlighted that people wanted an increase in activities within the home. While discussing the possible response to this, the registered person stated that she felt that all possible steps were being taken. She also felt, however, that the observation was less valid because it was staff who commented most about the lack of activities. This attitude did not demonstrate that all views were valued and given serious consideration, and so detracted from the quality assurance process. However the manager and registered person had responded to comments concerning the décor and general maintenance of the home. The need to enable people to comment anonymously was also discussed and the manager is considering whether to set up a suggestions box. Oldham Metropolitan Borough Council or relatives manage all finances and an invoice is sent for money spent. Records and receipts confirmed that equipment used in the home is checked and maintained in accordance with the manufactures recommendations and on the day of inspection the gas boilers were serviced. The manager also provided maintenance dates in the AQAA and these were all within the accepted period. A fire safety risk assessment has been completed. Accident records were examined and these had been dealt with appropriately and a manner that resulted in the best possible outcome for the person involved. During the tour of the home staff were observed using gloves and aprons correctly and in the main, cleaning fluids were stored safely. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 26 Appropriate posters promoting safe working practices and infection control were observed in the kitchen and the laundry room. Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 27 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 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 OP12 Good Practice Recommendations The registered person should provide people with the opportunities to participate in a choice of meaning full activities, based on their assessed interests and abilities, daily. This will prevent boredom and promote emotional and physical wellbeing. The manager should make sure that sufficient staff are on duty at all times, this will ensure that residents needs are fully met. 2 OP27 Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chamber Mount DS0000060625.V339699.R01.S.doc Version 5.2 Page 30 - 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!