Inspection on 10/12/07 for Chantry Care Services

This inspection was carried out on 10th December 2007.

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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chantry Care Services 07/01/10

Chantry Care Services 03/12/08

Chantry Care Services 07/03/07

Chantry Care Services 20/06/06

Chantry Care Services 01/03/06

Chantry Care Services 25/07/05

Chantry Care Services 11/09/04

Chantry Care Services 28/04/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Chantry Care Services 46 Dean Street Crediton Devon EX17 3EN Lead Inspector Vivien Stephens Unannounced Inspection 10th December 2007 10:00 Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 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 Chantry Care Services DS0000022048.V351181.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 Adults 18-65. 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. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chantry Care Services Address 46 Dean Street Crediton Devon EX17 3EN 01363 772301 01363 772348 intotal@aol.com 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) Chantry Care Services Michelle Jane Dermott Care Home 16 Category(ies) of Learning disability (16), Physical disability (4) registration, with number of places Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2007 Brief Description of the Service: The Chantry is a listed building, in Dean Street, close to the centre of Crediton. The premises are two-storey and detached and has an annexe previously known as ‘The Coachouse’ at No. 47. The large gardens include various outbuildings at the rear. There is some private parking. The home offers accommodation and care to sixteen service users with learning disabilities. There are lounges, a study/activities room and dining room on the ground floor. None of the bedrooms have en suite facilities, but all have wash hand basins. Since there is no lift between floors, clients accommodated on the first floor must be fully ambulant. Whilst the Home is registered to care for people with physical disabilities, careful assessments would be needed should any further admissions in this category be considered. The Home has its own transport. At the time of the inspection, fees ranged between £518 to £1050. On the notice board in the hall there is information telling people that a copy of the inspection report is available for them to read. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Several weeks before this inspection took place the home was asked to complete an Annual Quality Assurance Assessment. When the completed form was received by the Commission survey forms were sent to every person living in the home, their relatives, care managers and health professionals, and to each member of staff. Responses were received from four care managers, one health professional, five relatives, and 3 members of staff. We also spoke to a relative by telephone and another relative during the inspection. Their comments have helped us to form the judgements we reached in this report. This inspection began at approximately 10am and finished at approximately 6pm. During the day the inspector was joined by an ‘Expert by Experience’ and her supporter. This person used her experience of using services for people with learning disabilities to talk to people, look around the premises, and to consider what it might be like to live at the home. She gave her views on some of the good and bad things about the home. Her comments have been included throughout this report. On the day of this inspection there were 11 people living at the home. In addition three people regularly visit the home each weekday for day care. During the day we talked to the manager and three care staff on duty during the day. We carried out a tour of the home. We looked at the records the home is required to maintain. We talked to four people who live in the home and one relative who was visiting that day. What the service does well: During this inspection we heard many people praising the manager for her commitment and hard work, and for the depth of her knowledge and understanding of the individual needs of the people living at the home. We heard and saw many examples of how she has made significant improvements to the care plans that have helped the staff to gain a greater insight and understanding of the needs of each person living at The Chantry. No new people have moved into the home in the last year, but the home has good admission procedures that will ensure that anyone who may be thinking of moving in at any time in the future will have their needs carefully assessed, and they will be given good information and opportunities to visit and get to know the home before any decision to move in is made. Medicines are generally stored and administered safely. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 6 The home was able to demonstrate that all complaints and concerns they have received have been listened to, taken seriously, and acted upon in a satisfactory manner. The home has good procedures in place for handling and recording any money held on behalf of the people living in the home. We saw evidence of good recruitment procedures being followed to ensure that prospective new staff are entirely suitable for the job. There has been a good range of training provided to all staff in the last year. What has improved since the last inspection? What they could do better: While the home has excellent care plans in place, recently there has been high staff turnover. At the time of this inspection staffing levels were very low and we heard examples of where the staff had not had sufficient time to provide the level of support that was set out in the care plans. We heard that, at times, people do not always look tidy or well-dressed. Sometimes they are not given help to choose the clothes they buy, or where they go on holiday. The care plans clearly set out the activities each person enjoys, and the things they would like to do each day. However, low staffing levels at the time of this inspection prevented people from doing all of the things the home had agreed to help them do. We saw people wandering around in the hallway, lounge and dining room during the day while care staff struggled to do other household Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 7 tasks such as cooking and cleaning. Many of the people we contacted during this inspection told us the home needed to provide more activities, especially opportunities outside of the home. Where the home administers creams and lotions there should be clear written instructions to show how, where and when they should be applied, and what staff should do if the condition gets worse, or if it improves. Staff should record each time creams or lotions have been applied. At the time of this inspection any medicines that needed to be kept cool were stored in the main kitchen fridge. While the room the fridge is in is kept locked when not being used, we recommended that a secure fridge is provided that is kept at the right temperature according to the recommendations of the manufacturers’ of the medicines. The menus we saw showed that people receive a balanced and varied diet. However, our ‘Expert by Experience’ found that much of the food provided appeared to be either frozen or pre-prepared foods such as pizzas. People she talked to said they did not always have a choice of foods, and were not encouraged to help choose or prepare meals. A member of staff was standing up when helping a person to eat their meal. We have recommended that the home considers how they can make mealtimes a more pleasant experience for the people living in the home by increasing the choice, participation, and quality of the food. The complaints procedure is not displayed in the home. We suggested that the home should use pictures and symbols to help those people who may have difficulty in reading to understand what they should do if they have a concern or complaint. The home should help people to know how much money they have, and help them to work towards managing their own finances. We also recommended that the records of cash held and bank and building society accounts are double checked another person to ensure they are accurate and to safeguard people’s finances. The level of staff on duty on the day of this inspection was poor. Several staff have recently left, resulting in insufficient staff to cover each shift. The home needs to improve their staff retention in order to prevent more staff from leaving. The home also needs to continue to help those staff who have been recruited from overseas to improve their command of the English language and to help them communicate better with the people living in the home. Despite all of the work that has been carried out to improve the environment in the last year there were still areas that appeared old and worn. The home does not employ a regular maintenance person and therefore when furniture or decorations are damaged repairs are not always carried out as promptly as necessary. Some parts of the home presented a potential hazard to people with poor mobility. Some of the floorings appeared scuffed and scratched. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 8 Our ‘Expert by Experience’ said “I would not like to live here for health and safety reasons and it is not homely, more like an institution. We could see that decorations and upgrading the home was still underway at the time of our inspection and therefore it is likely that when the work is completed the overall effect is much more homely. However, we recommended that the home looks at what further work is needed to give the environment a more homely and welcoming appearance, and to ensure that this is included in any further work that is carried out. We were concerned to hear that the person recently recruited to the post of Deputy Manager only stayed for four days. The home has had insufficient management cover for many months, resulting in a great deal of pressure on the manager to achieve the improvements needed in the home single-handed. Some relatives told that, while they considered the manager was excellent, they were worried about the lack of deputy manager or senior care assistant structure within the home. 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. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who may be considering moving into The Chantry can be confident that their needs will be fully assessed, and they will be given enough information and opportunities to visit and get to know the home before any decision to move in is made. EVIDENCE: The Annual Quality Assurance Assessment completed by the home before this inspection gave the following information “ There have been no admissions to the home over the last two years but our procedure would be as follows. We would obtain a community care assessment from the social worker which we would then assess, if it was felt we could provide a service we would carry out our own comprehensive assessment, if after this assessment it was felt a service could definitely be provided the prospective client and family would be invited to come for a informal visit to the home to enable them to look around, meet staff and other clients. This may then be followed up by a tea time visit, overnight stays and weekend visits to ensure placement will be suitable.” Each of the care plan files we looked at during our visit contained a copy of the original assessment information. The files also included a copy of the service Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 11 user guide that had been given to the person when they moved in. This guide has been personalised with the person’s name. The guide has recently been improved to include a picture format to help people understand what it would be like to live in the home. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Person centred care plans show that the home aspires to provide exactly the right assistance to each person to meet their individual needs and preferences. However, they could do more to meet their commitment to provide the support as set out in the care plans, and to enable people to participate in the running of the home and make choices about their daily lives. EVIDENCE: We looked at four care plan files during this inspection. Since the last inspection all of the care plans have been re-written and significantly improved. We found they were all written in the first person, and wherever possible they used the exact words the person had said. Where the person had been unable to speak up for themselves we could see that a great deal of time and thought had been taken to try and tell the reader what the person would want to say. The plans were written in plain and easy to read language, and explained the strengths and weaknesses of each person, what they want Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 13 to do, what they can do for themselves, what they need help with, and how they want to be assisted. The plans covered every aspect of the person’s personal and health care needs in detail. Each section guides the reader to look at the risk assessments for that particular care need. The care plans included information on each person’s cultural and religious needs and preferences. The care plans showed how the staff have been instructed on how to respect the person’s privacy and dignity and how they will offer them choices. Examples of good practice advice included instructions on how the person wanted their food to be cut up for them, and how this should be done discretely in order to maintain their dignity. Another plan explained how to brush the person’s hair (this person did not like having their hair brushed and the plan explained how to help them without causing upset or distress). Given the level of detail in the care plans it was disappointing to hear from our ‘Expert by Experience’ about her observations at lunchtime. She told us “When I was there, I was watching a staff member standing up to feed a resident. I didn’t think this was good practice” (See also Lifestyle section). We could see that the care plans have been regularly reviewed in order to ensure they are always up-to-date and correct. Care staff have signed each section of the care plans to confirm they have read and understood them. Our ‘Expert by Experience’ talked to some of the people living in the home. She found out how the staff helped people to make decisions. She found some evidence of good practice – examples included one person who told her he could go to bed when he wanted. He also said that staff knocked on the door of his room to ask if they could come in. However, she also heard about some poor practice and where improvements could be made. One person she spoke to was a bit confused about choices and said he couldn’t get a snack or meals when he wanted them. He did not know why this was. She was also told the residents go on holidays at Butlins together and was told “Staff choose where they go”. The residents do not appear to have a say in this. Another person told her that staff do his clothes shopping and buy his toiletries for him – she wondered why this person couldn’t go out and choose his own. We talked to the manager about this. She said that some people like choosing their own clothes, while others don’t like going out to the shops, and in these cases the staff usually go and buy things on their behalf. We talked about ways of helping people be involved in choosing their own purchases, Either by taking to the shops before going to a pub or café, or by choosing things from a catalogue or on the internet. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 14 The home told us that they helped the people living in the home to choose the colour scheme of the new decorations by providing colour charts for people to look at, then painting two spare rooms in very different shades and one wall in large blocks of colours then asking people which colours they preferred. Since the last inspection the home has made significant improvements to the way they assess any potential risks to people’s health, safety and well-being. Each section of the care plan has been linked a risk assessment and we could see that the home has taken a great deal of time and thought to make sure that they give help to allow people to live their lives as they wish by giving help and support to minimise any potential risks. Advice has been sought from health and social care professionals where necessary. An example of good practice was seen in one risk assessment where the person was at risk of choking if they ate certain foods. Some of their favourite foods have in the past caused them to choke. The home has followed specialist advice on how to help them prepare food that the person liked, and that did not pose a significant health risk to them. One care manager told us the “Service has always acted upon advice given and have addressed concerns promptly and effectively. The service responds well to individual’s needs and provides person-centred care plans. The service asks for advice when required and provides extra staff without reimbursement.” Another care manager praised the service, saying “I have found the staff positive and willing to engage with me and any advice/suggestions I have made.” However, they also said the home needs to do more work to ensure they are up-to-date with the Mental Capacity Act “For example, not infringing on someone’s right to freedom by not enabling them to leave the care environment.” We talked to the manager, Michelle Dermott about the actions taken by the home to implement the new Act and she told us she had obtained details of the Act and had begun to consider what changes they may need to make in order to balance people’s right to freedom with a need to help them remain as safe as possible from harm. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has a strong commitment to helping people to lead fulfilling lifestyles as set out in their care plans, but low staffing levels have prevented them from achieving this adequately. People receive a balanced and varied diet but would benefit from greater choice and emphasis on good quality home prepared foods. EVIDENCE: When we arrived at the home there were just two staff on duty. We were told that two other staff had gone out in the minibus to collect three people who visit the home on weekdays for day care. (See staffing section for details of staffing levels). On arrival we found several of the people living in the home were milling around the entrance hallway and on the stairs and there was a sense of very little organised activities happening. We were told that the home could only provide limited activities at the time due to low staffing levels. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 16 One relative said they thought the home needed to improve the level of outside work and activities. A member of staff also said they thought the home should find more community activities. A relative who completed a survey form told us “The manager Michelle has welcome plans for more activities etc for the residents but is often hampered by shortages of staff.” In the dining room we saw a communication board that had photographs and pictures that showed the planned events for that day, including the staff on duty. This board has been put in place in the last six months and we were told that it has been very successful in helping people know what would happening that day. The care plans we looked at showed the individual daily preferences for activities. There was a ‘My Daily Routine’ section that had been drawn up using symbols to help each person have their own say about what they wanted to do each day/week. We heard that the regular planned activities outside of the home each week include – Mondays – Granny’s Meadows Tuesdays – Tuesday Club Wednesday – Coffee morning Thursdays – Skittles Fridays – a drive to the country or a walk into town. In addition to the above, one person goes out every day. One person attends college three times a week. If there are sufficient staff people go out to the cinema, pubs or other trips out. Activities provided in- house include arts and crafts, cookery, music, dance and story telling. During the day of our visit four people went out to a local gardening club known as ‘Granny’s Meadows’. There was an arts and crafts session held in the dining room for those people who stayed behind. The home has a mini bus and car that the residents use for transport. Some residents use public transport and a risk assessment has been carried out on these activities. Our ‘Expert by Experience’ talked to some of the residents and found out some of the things they do each day. One person said he liked living there because it was nice and quiet. He liked staying at the house but also liked going swimming at college, and doing some cooking. He told her that watching football and rugby on the TV was one of his main interests. He also went for meals out and going to the pub. Another person told her that he sometimes goes to a coffee morning at the church with some of the other people in the home. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 17 Another person talked about going to hydrotherapy every week. He said he liked living at The Chantry and that friends came to visit him. He goes gardening with some of the other residents 2 days each week, but spends 3 days at The Chantry. At home he plays games, does jigsaws and watches TV. In the evenings he goes out for a meal or down the pub. He told her that “what they do depends on what staff say”. He doesn’t help with preparing meals – staff do most of this for residents. “Residents are not allowed in the kitchen”. This did not worry him as staff get him whatever he wants to eat. He said that the staff were friendly. He told her the meals were nice but he does not get a choice of what he wants to eat. He was a bit confused about choices and said he couldn’t get a snack or meals when he wanted them. He did not know why this was. Our ‘Expert by Experience’ was told that people living in the home have been to Butlins on holiday together. “Staff choose where they go”. She found that the people living in the home did not appear to have had a say in this. We talked to the manager, Michelle Dermott about the level of activities. We could see that they were providing a basic level of activities each week but we were concerned that these did not match the assessed needs as set out in the care plans. We saw people ‘milling around’ in the home for much of the day, seemingly without much to do. We were told that the activities had increased significantly after our last inspection but recently several members of staff had left and, at the time of this inspection, they did not have sufficient staff to provide the level of activities they would normally expect to provide. A relative who was visiting the home on the day told us that the manager is very good at keeping in touch with her. She said she is consulted about everything concerning her son. Another relative who lives a long way from the home also praised the manager, saying that she does her best to help her visit her son as often as possible, sometimes by providing transport to meet her halfway. The care plans we looked at included a detailed section on nutrition and eating. The plans covered individual likes and dislikes, dietary needs, weight loss/gain, and any special instructions to staff, for example, if the person needed help to cut their food up. The staff follow a weekly menu for meals. The menu has a paragraph telling people that different choices of meals always available including cultural or vegetarian dishes. We were told that the main meal each day is home cooked using fresh ingredients wherever possible. However, our ‘Expert by Experience’ joined the people living in the home for the midday meal. She found that the food was frozen or ready meal type. A relative also told us they were concerned that only the cheapest food is purchased, and many of the meals Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 18 are convenience foods. We talked to the manager about this but she said that meals are usually home cooked using ingredients of a good standard. Our ‘Expert by Experience’ saw a staff member standing up to feed a resident and she felt this demonstrated poor practice, and looked as though the staff member was too busy to sit down and give the person their full attention. We talked to the manager about this and she agreed it was not acceptable and said she would make sure it does not happen again. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Excellent care plans show that the home has a very clear understanding of the personal and healthcare needs of the people living in the home, but at times they have failed to meet those needs fully. Medicines are generally stored and administered safely, although there are some areas where minor improvements could be made. EVIDENCE: The care plans we looked at contained excellent detail about the way people wanted to be supported by the care staff in every aspect of their personal care needs. They gave very clear instructions to staff about how each task should be carried out in order to maintain the person’s privacy, dignity, choice and independence. The plans contained information about every aspect of their preferred daily routine, for example, times of waking/going to bed, how the person wants to be helped with washing, dressing, brushing teeth, and brushing hair. They also showed where the person is able to carry out these tasks themselves, guiding the care staff to help the person remain as independent as possible. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 20 While many of the relatives who contacted us before or during this inspection recognised that there have been many improvements in the home over the last 12 months some told us that recent staffing problems have resulted in people not always receiving the level of personal care that has been agreed in the care plans. Two relatives told us about concerns over their son/daughter’s appearance. They told us that staff have failed to ensure clothing is changed regularly and that the person always goes out looking neat and tidy. Information provided by the home before this inspection took place states that they make sure females living in the home receive personal care from a member of staff of the same sex. During the inspection the manager told us about the health needs of the people living at the home. We heard how they have liaised closely with health professionals to ensure that people receive advice and treatment wherever necessary. We also heard how the home has recognised the risk of some people developing illnesses such as early-onset dementia and how they have provided information to staff on such illnesses. They hope to provide further training on specific health topics when courses become available. The care plans we looked at contained evidence to show the home has liaised closely with the relevant health care professionals when people have developed health problems, and the plans also contained clear information about what staff should do if the conditions recurred. One health professional told us “The manager has introduced many improvements over the last 12 months and readily accepts new techniques/ways of doing things.” On the day of this inspection a physiotherapist visited the home to help one person with their mobility problems. We looked at the way the home stores, administers and records medicines. The home uses a monthly monitored dosage system supplied in blister packs from a local pharmacy. The medicines have been recorded into the home, and each tablet or medicines has been recorded correctly when given. Most medicines have been stored securely with the exception of any medicines that need to be kept cool. These have been kept in the main fridge in the pantry. The pantry is kept locked when not in use, providing partial security. However, the main fridge may not be at the right temperature for medicines and therefore is not ideal. Creams and lotions have not been recorded after they have been applied. The administration records and care plans did not give clear guidance on how, where and when the creams should be applied, or what to do if the condition either improves or gets worse. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 21 Earlier this year the manager received training to a nationally recognised standard on the safe administration of medicines. Since then she has provided training to the staff team on the same topics covered. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People can be confident that the home will listen to and act upon any concerns or complaints satisfactorily although they would benefit from better information about how to complain. The home has good procedures in place for handling and recording any money held on behalf of the people living in the home, but could do more to help people work towards managing their own finances EVIDENCE: The information provided by the home before this inspection showed that they have received 10 complaints in the last year. We looked at the records they have completed following each of these complaints and we found they have all been thoroughly investigated and actions have been taken where necessary. We found that people have been encouraged to voice their concerns at any time and the home has listened and taken all concerns seriously. No complaints have been received by the Commission since the last inspection. Each person has been given a copy of the complaints procedure in the service user guide. However, the procedure has not been displayed in the home – we talked to the manager about the possibility of using symbols to help people understand what they should do if they have a complaint. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 23 All staff have received training on the protection of vulnerable adults (this was confirmed by the care staff we talked to). The home has policies and procedures in place covering all aspects of prevention of abuse including whistle blowing. We were told that the home plans to provide refresher training on this subject over the next year. We checked the records of cash and savings handled by the home on behalf of the people living there. We found the records were clear and accurate. The records of bank and building society accounts have not been checked by a second person to ensure they are correct. We talked to the manager about how this could be achieved in order to provide added safeguards for people’s savings. Our ‘Expert by Experience’ talked to one of the people living in the home about how the staff helped him to handle his money. She was told that staff looked after his money but they never tell him how much he has left. We talked to the manager about this. She told us that people are always told how much cash they have left in their money tins, and she always asks their permission before withdrawing cash from their bank or building society accounts. However, she said she does not tell them how much money they have in their bank or building society account. She agreed that they will do this in future. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Major improvements have been made to the environment over the last year, but further work is still needed to create a homely and safe environment. EVIDENCE: In the last year the owners of the home have spent a considerable amount of money on repairs, maintenance and improvements in the home. The roof has been replaced and many areas have been redecorated. New furniture and fittings have been purchased and many bedrooms now appear much more homely and personalised. Some attractive light fittings, pictures and mirrors have been provided throughout the home. On the day of this inspection workmen were decorating the back staircase. Information provided by the home before this inspection showed that the people living in the home have chosen the colour schemes. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 25 While some relatives and professionals told us they recognised and appreciated the many improvements to the environment in the last year, we found there were still a number of areas that appeared tired and worn. These areas had become even more noticeable against the areas that have been redecorated and improved. On the day of this inspection we found various areas where repairs and maintenance continued to be a problem. In one bedroom a chest of drawers had collapsed and the bed was unmade. In the downstairs bathroom a cupboard door catch had broken and the door was wedged open. In the Coach House we could see that upgrading is continuing but the property still wasn’t ready for occupation. Our ‘Expert by Experience’ told us about some areas she thought were a possible hazard for people who may have mobility problems • • • • Uneven surfaces to the rear of the building with no handrail. Loose fittings in one toilet At the front entrance a mat with wood surround was a trip hazard. A banister was loose on the stairs She also said her overall impression of the environment was that it felt like an institution. We talked to the manager about what could be done to try and create a more homely atmosphere. We could see that work on upgrading the home was still under way and that when the work is been finished this may change visitors’ impression of the home. We also recognised that the home needs regular maintenance to keep it looking good. The manager agreed to talk to the owners about some of the finishing touches that could make a difference to the appearance to the home. We also discussed the difficulties the home had experienced recently due to staff shortages. The care staff carry out cleaning, cooking and laundry duties as well as providing personal care to the people living in the home. The home does not employ a regular maintenance person and therefore the care staff also have to carry out minor repairs from time to time. On the day of this inspection we saw a member of staff attempting to deal with the broken chest of drawers. We also saw care staff making beds and carrying out cleaning duties. On the day of this inspection we found many areas appeared clean, although the areas where the workmen were decorating were understandably dusty. Our ‘Expert by Experience’ found that one toilet was very dirty and she was concerned that staff had been unable to clean it promptly. However, when we returned to check it a little while later we found that staff had noticed the problem and had cleaned it. The manager told us that they planned to implement a cleaning schedule for the home once the redecorating has been finished. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has failed to take sufficient action to prevent high staff turnover, resulting in poor staffing levels and failure to meet people’s assessed needs. There has been a significant improvement in staff training in the last year, but low staffing levels has prevented staff from practising the good care they have been trained to provide. EVIDENCE: On arrival at the home there were two members of staff in the house and two more staff had gone out in the minibus to collect three people who visit the home each weekday for day care. The manager arrived shortly afterwards. At our last inspection we found there were usually six care staff on duty plus the manager. The manager told us that the ideal staffing levels that agreed with the owner of the home are for seven or eight care staff during the day. In recent weeks three full time care workers have left and this had resulted in the home only being able to provide at most, four care staff plus the manager – this is approximately half the level of staff considered to be necessary. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 27 On the day of this inspection we saw people ‘milling around’ in the entrance hallway with nothing to do. The staff appeared to be rushed and had little time to provide individual care or activities for people. Among the many duties they had to carry out they had to answer the door and deal with visitors (including ourselves, a physiotherapist and her assistant, and a relative). They had to cook meals, make beds, carry out cleaning tasks, and a member of staff also attempted to repair a broken chest of drawers. They also had to cope with and work around the workmen in the home. At the time of this inspection there were 6 full time staff vacancies. Relatives and professionals told us they were concerned about staff turnover and low staffing levels. They gave us examples of lack of individual care and insufficient activities in the home they had seen when visiting in recent weeks (these are explained in other parts of this report). Some of the comments we received included one from a relative who completed a survey form who told us “As with most care homes there seems to be new care staff coming and going within a short time. I don’t know if they have experience or training for people with Autism.” Another said (the home could improve by) “If possible fewer changes in staff, ongoing training for when new staff are appointed, in particular the understanding of Autism.” Elsewhere in this report we have given examples of poor practice, for example, a member of staff standing up when assisting a person with their meal, and we concluded that this was due to high staff turnover and insufficient staffing levels at the time of this inspection. Only one new member of staff had been recruited since the last inspection. The person had been recruited from overseas. We checked their recruitment records and found that all checks and references required by legislation had been taken up satisfactorily before they started work. We also saw that they had a Home Office work permit. Almost half of the staff team have been recruited from overseas. The manager told us that the home had experienced difficulties in recruiting staff from the local area and had found the only way to attract new staff had been from overseas. They recognised that language had been a problem in the past but they have found ways of helping them to improved their command of English including attendance at English classes. However, we found that language difficulties still pose a problem. A health professional who completed a survey form before this inspection told us “Sometimes the fact that English is a second language for some of the staff can pose problems when explaining strategies to them and helping them to implement them with the clients.” A relative also said “Our only slight concern is that there is a number of foreign nationals employed whose English language skills could be better.” We looked at the training provided to the staff in the last two years. We saw that staff have received a range of training on the type of disabilities the people living in the home have, including Autism. A care manager told us “I’m Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 28 currently providing a lot of training, but the staff team have become more unstable with people leaving recently”. On the other hand a care manager who completed a survey form told us how the home could improve - “It could achieve better Autism understanding” and another health professionals said the home could improve by “Regular training of all staff in dealing with and caring for people with Autism.” We were unable to find out how recently they had visited or whether the training earlier this year had resulted in improved practice. However, we also considered that low staffing levels and high staff turnover might have resulted in care staff not being able to follow the good practice training they have received. Our ‘Expert by Experience’ overheard a member of staff used the words “wheelchair bound” for a resident who is a wheelchair user and she felt this demonstrated a lack of awareness of currently accepted terminology. We talked to the staff on duty during this inspection to find out why staff had left recently. They told us that staff had found better paid work elsewhere. We were given details of the training that has been given to the staff over the last year. All staff have received induction in the past, but those staff who were recruited several years ago the level of induction may have been poor and therefore the manager told us that all staff are currently working through a nationally recognised induction programme to ensure they all have the basic knowledge required. The records of training provided on the day of this inspection showed that eight out of the ten staff have achieved a nationally recognised qualification in care known as a National Vocational Qualification (NVQ) or equivalent. Other staff training over the last 2 years has included health and safety topics, protection of vulnerable adults, picture boards, autism, gentle teaching, challenging behaviour, the ‘six values’, safe administration of medicines, and company policies. At the last inspection it was recommended that the induction and foundation training is accredited by the Learning Disability Award Framework. This has now been started. The manager told us that they aim to have regular staff meetings (we saw minutes of the last meeting on 23rd November 2007) and individual staff supervision every 8 weeks, although she said this has been difficult to achieve recently due to low staffing levels. We talked to the staff on duty about the level of support they receive and we were told that this has improved under the current manager. They told us they now feel involved in the home and consulted over matters of importance. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is run by a committed and competent manager, but the smooth running of the home is hampered by the lack of management support and low staffing levels within the home. EVIDENCE: Throughout this inspection many people told us how much they appreciated the skills and dedication of the manager, Michelle Dermott. Comments included – “The manager, Michelle, is very understanding and willing to help….she could not be kinder or more approachable.” “Michelle is a committed and skilled manager, learning quickly about a new client group.” Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 30 We heard that the manager has worked long hours over the last year in order to achieve the improvements that we had required following previous inspections. She has worked without the support of a deputy manager or senior staff team to help with management tasks. A Deputy manager had recently been recruited but this person left after working in the home for only four days. Two relatives told us they were concerned about the pressure placed on the manager to run the home without a Deputy Manager or sufficient Senior Care staff to ensure staff are adequately supervised. Michelle Dermott has achieved NVQ level 4 in management and the Registered Manager’s Award. She is working towards NVQ level 4 in care. She has worked for a number of years in a care setting. The company employs an Area Manager who visits on a monthly basis to provide support to the manager and carry out checks on the care and services provided. The Company Director visits the home every three months. The home has developed their own quality assurance system including questionnaires to relatives and professionals who visit the home. The replies from their recent survey were in the process of being returned at the time of this inspection. During this inspection we looked at the records the home has maintained in respect of health and safety. The fire logbook showed that equipment had been serviced and tested regularly, and staff had received regular fire drills and training. The home has health and safety and control of hazardous substances policies and procedures in place, and environmental risk assessments. Yearly gas safety checks and regular electrical checks have been carried out by suitably qualified contractors. Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 1 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 2 3 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 2 X 3 X X 3 x Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 32 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 YA24 Regulation 23(2) Requirement The home should be kept in a good state of repair and must be free from any hazards. Particular attention should be given to - Uneven surfaces to the rear of the building with no handrail. - Loose fittings in one toilet - The wood surround to the mat in the entrance hall may be a trip hazard. - The banister was loose on the stairs There should at all times be sufficient staff on duty to meet the needs of the people living in the home. Timescale for action 01/03/08 2 YA33 18(1)(a) 01/02/08 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 YA7 Good Practice Recommendations The home should help people make choices and decisions about how they want to lead their lives, including what DS0000022048.V351181.R01.S.doc Version 5.2 Page 33 Chantry Care Services 2 YA8 3 4 YA13 YA14 5 YA17 6 7 YA17 YA18 8 YA20 9 YA20 10 11 12 YA22 YA23 YA23 clothes they buy and how they spend their money. The home should help people have greater participation in the day-to-day running of the home, including meal planning and preparation and where they want to go on holiday. The home should improve the level of education, work and leisure activities outside of the home. The range of leisure activities should be increased through consultation and improved communication with all residents in order to tailor their weekly activities to the individual interests and activities as agreed in the care plans The home should work towards making mealtimes a pleasurable experience. Mealtimes should be relaxed and unhurried. There should be sufficient staff on duty to be able to sit down and help any people who need assistance with their meals in a sensitive and discrete manner. People should be encouraged to participate in all aspects of meal planning and preparation. The home should aim to provide a good choice and variety of nutritious and appetising home-prepared meals using good quality ingredients. Snacks should be available on request at all times (according to individual dietary needs). Where people need help to eat their meals, staff should provide assistance in a sensitive, discreet and unhurried manner. Staff should provide appropriate support to ensure that people’s clothing is in good order and their hairstyles are neat and reflect their personality, ensuring that they maintain their dignity at all times. The home should record when creams and lotions have been applied. There should be clear instructions to staff on where, when and how the cream or lotions should be applied, and what action they should take if the condition improves or worsens. Medicines that need to be kept cool should be stored in a secure refrigerator that is kept at the right temperature for the medicines according to the manufacturers recommendations. The complaints procedure should be displayed clearly in the home and available in alternative formats according to the needs of the people living in the home. There should be a system of double-checking the records of money handled by the home on behalf of people living there to ensure that all savings and cash are correct. The home should improve the way they help people to understand how much money they have, how much they spend, and how much they have left. DS0000022048.V351181.R01.S.doc Version 5.2 Page 34 Chantry Care Services 13 YA24 Arrangements should be made for the staff to record any areas where repairs and maintenance are necessary. Arrangements should be made for regular routine repairs and maintenance of the home to be carried out. Further work is needed to create a homely and wellmaintained environment. The home should ensure that staff are able to communicate well with people and have a good command of the English language. The home should be able to demonstrate they have good staff recruitment and retention, and have a low turnover of staff. Consideration should be given to the management structure within the home to ensure there are sufficient senior staff employed, and there is adequate senior/management cover at all times. 14 15 16 17 YA24 YA32 YA33 YA37 Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Chantry Care Services DS0000022048.V351181.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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