CARE HOMES FOR OLDER PEOPLE
Chandos House Gorse Road Grantham Lincolnshire NG31 9LH Lead Inspector
Julie Western Unannounced 14 July 2005 @ 09.30 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 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. Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Chandos House Address Gorse Road Grantham Lincolnshire NG31 9LH 01476 562393 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Order of St John Care Trust Miss J Garrill Care Home 33 Category(ies) of Old Age (OP) - 33 registration, with number of places Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 24/11/05 Brief Description of the Service: Chandos House forms part of the Orders of St John Care Trust, a voluntary organisation. The care home is situated in a quiet residential area to the north east of the town of Grantham. There are some limited local amenities available in the area. The town centre is not within walking distance but there are various forms of transport available to facilitate easy access. The home, a former Local Authority provision, was purpose built to admit older people. It has large landscaped gardens and on-site car parking. Accommodation for service users is available on the ground floor and the first floor, with access to the first floor being via stairs or a shaft lift. The home provides permanent and respite care for up to 33 older persons and at the time of the inspection, 32 people were being accommodated. The registered manager was present for the majority of the inspection. Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 5 hours. A partial tour of the building took place and care records were inspected. The main method of inspection used was called ‘case-tracking’; this involved selecting three residents and tracking the care they received through the checking of their records, discussions with residents and care staff and observation of practices. Some policies and procedures were examined and records concerning the safety of the home were also seen. Four of the 32 residents, 6 of the 31 care and ancillary staff and two visitors were spoken with. The Manager was present throughout the inspection. What the service does well: What has improved since the last inspection?
The Manager of the home was on leave; however, all records were available for inspection and clearly labelled. The rolling maintenance programme was still in progress, 2 bedrooms having been recently redecorated. The entrance hall had been refurbished and the residents’ smoking room had been relocated in order to create a new quiet room for residents. A second hoist had been purchased in the light of the changing needs of residents. There has been an improvement in record keeping. Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 6 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. Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 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 standard(s) 1,3-6 The home clearly sets out what it intends to do for its residents and this information is freely available to residents. Prospective residents are encouraged to take time before making the decision to move into the home on a permanent basis. EVIDENCE: The statement of purpose was examined and was very comprehensive. It contained several inspection reports. The Manager said a copy of the statement of purpose was in the brochure pack, which was sent or given to all prospective residents or their families. The pack included a copy of the residents’ handbook and a copy of the latest Orders of St. John Care Trust quarterly magazine. Prospective residents were given a chance to experience life in a residential care home, spending a day and having meals in the home. Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 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 standard(s) 7-11 The home’s records give a clear indication of the needs of residents and enable staff to meet their needs with sensitivity and regard for their privacy and dignity. EVIDENCE: The three care plans looked at in depth contained clear and comprehensive assessments, were reviewed regularly and were signed where possible by the service user or relatives/advocates. There was a clear medication policy and the most recent visit from the pharmacist was 21/4/05, from which there were no requirements. Residents said they felt safe and well looked after; one resident commented ‘the staff are very nice’. The staff team were observed carrying out their duties with kindness and sensitivity towards the residents, especially when attending to their personal needs. A visiting nurse said that the standard of care at the home was very good and the care staff were ‘brilliant, helpful and very knowledgeable’. Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 10 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 standard(s) 12,13,15 A variety of events and activities are available, which residents are informed about. The home would benefit from the presence of an activities co-ordinator to organise events. The residents exercise choice about which activities, if any, they wish to participate in and what meals they want to eat. EVIDENCE: Although one resident said ‘not much goes on here, others said that there were a number of activities at the home, including bingo, entertainers and music and movements; these were usually advertised on the notice board near the dining room. Carers said that when the weather was good, they took residents out for coffee, walks, shopping or to the local garden centre. The Care Leader said that events were not on a planned basis and therefore lacked any continuity as care staff did not have a lot of time to devote to this. time to plan any activities. The Manager had already identified this as an issue and was advertising for a 10-hour post of activities co-ordinator. The midday meal was balanced, nutritious and easy for older people to eat; one resident said ‘the food’s very good – the cook will come round every day and ask for our choice’. There was a menu board displaying the day’s meals including the alternative choice. Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 16-18 The home’s complaints procedure is clear and gives residents and their relatives the confidence that comments and concerns will be listened to; there is a robust adult protection procedure. Staff members need training on adult protection. EVIDENCE: Residents and visitors to the home all said they did not wish to complain but knew how to make a complaint. The home had received no complaints in the last twelve months. There was a clear adult protection procedure, which was linked to the Local Authority procedures. Some staff members spoken with had not received training on adult protection issues. Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 19-26 The residents live in a comfortable and pleasant environment with both private and communal space, which is generally suitable for their needs. EVIDENCE: Overall the standard of decorations internally and in the gardens was generally good and afforded residents a good degree of comfort. One resident said ‘this is the best home I’ve been in and my room’s very comfortable.’ The home has a rolling maintenance rota, two bedrooms having been recently redecorated, and risk assessments are carried out on the premises to ensure that residents are safe from any potential hazards.. The entrance hall had been refurbished and the residents’ smoking room had been relocated in order to create a new quiet room for residents. The dining-room carpet, however, was dirty and stained. The administrator said that plans to resurface the yard to the rear of the premises had been budgeted for. Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 Staff numbers are in sufficient quantity for them to be able to care for the residents. Staff members are suitably trained, qualified and competent; they undergo an induction programme before commencing their duties. EVIDENCE: The residents were very positive about the care they received from the staff. One said ‘they’re very nice and sociable’. The most recent staff member to be appointed confirmed that she had given two references, which were followed up, a CRB check and undertaken an induction programme before commencing work. Training records were not seen but staff said that statutory training was completed with recent specialist training being on infection control. Eleven staff members had National Vocational Qualification at Level 2 with five having NVQ at Level 3. A full staff meeting was held two weeks ago and minutes were available for all staff. The staff rota showed that there were enough staff numbers according to the staffing matrix and shifts were staggered to accommodate the needs of residents. Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,35,38 The home is managed competently and the staff are supported and supervised in carrying out their respective roles. The views of residents are listened to and they are involved in decisions affecting them. EVIDENCE: The registered Manager is progressing towards the NVQ Manager’s award at Level 4. The quality assurance manual demonstrated a positive approach to seeking the views of residents and residents spoken with said they were constantly asked for their views on matters concerning the running of the home. There was a record of meals with satisfaction, complaints and concerns logged. The home has the International Standards Organisation 9000 award and the Investors in People award. Relatives said that they felt very much a part of the home; one said ‘I’m invited to all the do’s here and asked for my opinions as well’. Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x x 3 x x 3 Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 16 Yes Are there any outstanding requirements from the last inspection? 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 OP12 Regulation 16[2](m), (n) Requirement The registered person must consult service users about their social interests and make arrangements to enable them to engage in local, social and community avctivities. The registered person must clean the living room carpet. Timescale for action 8th September 2005 2. OP19 23[2][b] 6th September 2005 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 Good Practice Recommendations Chandos House C53 C04 S2344 Chandos House V238896 140705 Stage 4.doc Version 1.40 Page 17 Commission for Social Care Inspection Unity House, The Point Weaver Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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