Inspection on 20/06/06 for Chantry Care Services

This inspection was carried out on 20th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 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 10/12/07

Chantry Care Services 07/03/07

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 Susan Lyons 20th June 2006. 09:45 Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 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.V288946.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V288946.R01.S.doc Version 5.1 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 Mr Philip James Marshall Care Home 16 Category(ies) of Learning disability (16), Physical disability (4) registration, with number of places Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2006 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 includes 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 £500 to £1600. 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.V288946.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This home is registered to accommodate sixteen residents, on the day of the inspection there were thirteen residents living at the home. The home also provides day care for four clients Monday and Friday and for three clients Tuesday, Wednesday and Thursday. Day care is not regulated or inspected by the Commission for Social Care Inspection. It is difficult to obtain verbal feedback from residents therefore the inspection was completed by looking at records and surveys, talking to staff and the deputy manager and through observation of practice. This was an unannounced inspection which took place over two days. Prior to the inspection, survey cards were sent out as follows, Surveys Sent To Staff members Relatives Residents Care Managers GPs Specialist Health care Professional How Many Sent 15 7 9 9 2 1 How Many Returned 10 4 4 1 2 1 A new management team started at the home at the beginning of the year. One relative who had not been sent a comment card wrote to the inspector and commented on the improvements to the home since the new management team have been in place. On the day of the inspection the inspector was assisted by the Deputy Manager who was very helpful, open and demonstrated a good understanding of the needs of residents and the home in general. What the service does well: Positive comments about the home were received from the two GPs with whom residents are registered, one specialist health professional and a care manager. One relative felt that the new management team needed to be given a chance and one said that things seem to be better now with the new management team in place. Assessments have been completed within the home and one assessment completed by a care manager was seen. There have been no new residents admitted to the home since the last inspection. It is good to see that progress has been made in meeting resident’s cultural needs in spiritual and dietary areas. Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 6 Individual risk assessments were seen to be in place, which have been completed within the last twelve months. The home makes a lot of effort to encourage residents to maintain relationships with relatives. They will help to do this by taking residents to visit in the home’s transport. Residents are taken to see the GP when it is required and medication was seen to be stored securely and the records completed, as they should be. Records were seen for staff who have been recently recruited and the correct checks were seen to have been completed and a record of the interview undertaken. What has improved since the last inspection? What they could do better: One of the main problems in the home is that there are not enough staff to undertake activities with residents. Staff who are available seem to lack any knowledge of how to provide varied and meaningful activities. The home needs to ensure that they are able to meet the communication needs of all the residents and details of this need to be included on care plans as well as details in relation to special eating needs and cultural and spiritual needs. Risk assessments need to be more individualised. Individual contact within the community needs to be provided and the home needs to think of ways in which they can enable residents to make choices in their lives. Staff should ensure that doors are left open for residents to move in and out of the home and the menus need to contain less starchy food. Residents need to be involved in the planning of meals. Residents should be offered regular dental and optical appointments and different ways of obtaining medical support need to be used to meet residents individual needs. Complaints concerns need to be recorded and the action taken to remedy them and staff need to receive input in relation to adult protection procedures. The home is poorly maintained and needs to submit a redecoration and repair programme to the commission which addresses all the areas outlined in this Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 7 report. Action needs to be taken to ensure that there are no unpleasant odours within the home. Currently the home does not have 50 of their staff team trained to NVQ level 2 and there has been a lack of other relevant training within the home. Staffing levels need to be looked at so that there are sufficient staff on duty to meet residents needs both during the day and at night. Some consideration needs to be given to the time delay between expenditure being asked for and permission being sought from the provider. A quality assurance programme needs to be in place within the home. This means that residents and their representatives will have the opportunity to express their views about the home. Sufficient staff need to be trained in First Aid to ensure that there is one such trained member of staff on each shift including nights. Chemicals hazardous to health need to be locked away when not in use. All staff must receive fire safety training and the fire alarms should be tested weekly. 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. Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 8 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.V288946.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s needs are identified but not always met. EVIDENCE: There have been no new admissions since the last inspection. Many of the residents have been at the home for several years and may not have a copy of the shared assessment, health and social services. However all the residents files which were looked at contained copies of an in-house assessment of needs which covered all the appropriate areas. However they are not always followed through to the care plan. A copy of a shared assessment was seen for one resident which had been completed since the resident was at the home. Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is clear care planning in place with more detail staff will be able to consistently meet residents needs. There are limited opportunities for residents to exercise choice. Risk assessments where available support residents in independence but need to be more individualised. EVIDENCE: Care plans were looked at for seven residents. It was good to see that the care plans are being evaluated more frequently than every six months. Whilst the care plans do contain details of how needs are to be met, in discussion with staff it appears that they are not always up to date. In particular, recently changed needs of one resident in relation to eating have not been included in the care plan and although the inspector heard of some new work which has been undertaken to meet spiritual and cultural needs this has not been included in the care plan. Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 11 Programmes of how specific behaviour is to be addressed are included as part of the care plan but although some behaviour the inspector witnessed was mentioned on the evaluation sheet the guidelines in relation to how staff were to deal with it were not clear. The inspector was told that residents who are able to go shopping for their own clothes with staff. One resident went out with a member of staff to choose his lunch whilst the inspector was at the home. However in the daily recording there is little evidence of how residents are offered choice on a day-to-day basis. The inspector noted on one occasion a member of staff handing residents a biscuit from a container rather than letting them choose one. Staff told the inspector that residents meetings are held and residents are asked what they would like to do and if they wanted changes to their rooms. These meetings are not, however, minuted. This means that not all staff will be aware of what is discussed at these meetings. Risk assessment in relation to individual residents were seen on their files, which detail areas of risk and how they are to be minimised. However these do not appear to be individualised, the same risk assessments are included for each resident. Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Access to the community and activities are limited and not individualised meaning that care is not person centred. The home is excellent in supporting residents with family relationships and generally recognises resident’s rights and responsibilities. Meals provided are adequate but need improving to make sure residents have a fully balanced diet that they are involved in planning. Lack of resident involvement in the planning means that residents are unable to exercise choice. EVIDENCE: Recommendations have been made in the past in relation to activities for residents. This still remains an area of concern to some parents who told the inspector that their relative is not offered activities and spends much of the Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 13 time wandering around the home and grounds. The inspector noted on one morning no activities were made available to residents apart from watching television. Only one resident seemed to be interested in the DVD, which was being shown other residents wandered in or out of the room or paced up and down within the home or the garden. On other occasions when the inspector was in the home no activities were seen to be offered to residents although a group of residents did go out for a drive. The daily recording indicated that several residents do not go out very often apart from a ride in the mini bus or going in the mini bus when day care clients are picked up or taken home. On one residents assessment it said that he enjoyed walking swimming and gardening in the past months daily recording there was no mention of him being offered the opportunity to go swimming or gardening although it was recorded on three occasions in the month that he had been for a walk, twice had been out to play skittles, once to a picnic and to a craft group on one occasion. Another residents care plan records that the only exercise the resident will undertake is swimming. There is no record of her being offered the opportunity to go swimming in the last month. The resident’s key worker said that she really liked swimming but that there were not enough staff on duty to take her. Although the home is set within a residential area of Crediton there is little evidence to suggest that residents are part of the local community. Records indicate that most of the limited activities which take place outside of the home are drives in the minibus. There are occasions when residents play skittles at a local inn and the inspector was informed that some residents have been shopping for clothes but there is no evidence of regular community contact. Feedback received from relatives indicates that they are welcome at the home at any time. The home does make considerable efforts to maintain family relationships by providing transport for residents to visit their relatives when required. At the inspection staff were seen to knock before entering a residents room. Residents preferred form of address is detailed on care plans and residents mail is opened with them by a member of staff if required. Residents do have unrestricted access to the house and grounds although it was noted on an occasion that the door from the garden to the main house was locked. The deputy manager said that this should be open for residents to move freely in and out of the garden. The menus indicate that a varied diet is provided but the inspector felt that it was a little starchy on some occasions. The deputy manager has already identified this and intends to change the way in which the meals are planned and to give residents much more involvement in the planning and preparation where possible. It was good to see that some progress has been made in meeting specific cultural needs of one resident in relation to their diet. Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of specific equipment potentially places a resident at risk and residents needs in relation to communication are not met. Poor recording systems mean that all residents’ healthcare needs may not be fully met. Medication procedures protect residents. EVIDENCE: Where required, aids in relation to mobility are provided, and details of exercises etc. were available for staff use. However the home had not replaced a blender required in relation to preparation of meals for one resident, which was needed to meet the needs identified by a Speech & Language Therapist. Although it is good to see that these professionals have been involved in the care of the resident any change to the way in which food is prepared should be checked with them and a risk assessment needs to be in place in relation to the changed needs of this resident. Since the inspection the inspector has been told that the blender has been replaced. At the last inspection a requirement was made that the communication needs of residents should be met by all staff. This was in relation to a communication board for one resident which was Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 15 not being used consistently, by all staff. The situation remains the same. The manager said at the last inspection that staff were provisionally booked on a Total Communication course. This has not taken place. It was also noted that communication needs for other residents and the way in which they are met although mentioned in assessments were not followed through to the care plans. Staff are not trained in basic communication skills such as Makaton which residents are familiar with. Service users have specific care needs however staff are not fully equipped to meet them particularly in relation to behavioural issues. (See Standard 35) It is good to see that considerable progress has been made in meeting individual residents cultural and spiritual needs through the ordering of specific spiritual aids. Surveys received from two GP surgeries indicate a positive response in relation to the home. A further survey from a specialist health professional indicates that there has been improvement under the new management of the home. Some discussion took place in relation to one resident who staff are concerned about and who will not attend the GP surgery. Staff have not been proactive in looking at other ways of meeting this residents needs and this potentially places the resident at risk. It was not always possible to establish when residents had last attended dental and optical appointments. It appeared that these were overdue in some cases. The medication storage and records were seen to be maintained appropriately. Staff who administer medication have received training from the local pharmacy who provides the monitored dosage system which the home uses. Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by the complaints procedure but more detail is required in recording. Staff receive inadequate guidance/training EVIDENCE: The home has a complaints procedure but lack of recording means that it is difficult to monitor complaints and concetrns received. Some relatives on their survey forms said that they were not aware of the procedure. The complaints procedure says that all complaints and concerns will be recorded. The complaints record is empty although the inspector was told that some relatives have expressed concerns/complaints about specific issues. Not all staff have received training or watched a video in relation to The Protection of Vulnerable Adults. Staff who were asked, were able to say what they would do if they saw a resident being treated inappropriately Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of the décor, repair and specific areas of hygiene within the home are poor with no evidence of improvement or planning which does not provide residents with a pleasant environment in which to live. EVIDENCE: Following the last inspection a requirement was made that a redecoration programme was to be submitted to the Commission. This has not happened. Considerable damage to the interior decoration has been caused by a leaking roof and a leaking water tank. There are also areas where paper is coming away from walls and ceilings and there are small dents. On previous inspections requirements have been made that chipped and broken tiles in bathrooms and toilets need to be repaired and replaced. In several areas the sealant around baths and washbasins needs to be replaced. Many of the carpets are stained and the inspector was told that although they have tried to remove the stains it appears to have made them worse. On the back stairs there is window in the roof, which looks to be covered with non-glass material, this appears discoloured and broken. There appear to be some damp areas in Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 18 some rooms. A temporary repair has been made to the leaking roof but it requires a permanent repair to be made. The deputy manager said that they have been given permission to obtain quotes for the redecoration of the home. Since the last inspection the sofa and armchairs in the lounge have been replaced. Furniture around the home is domestic in nature unless it needs to specialist to meet residents needs. At the front of the house there is a small cobbled area this contains weeds and tubs with only one shrub visible the other plants in the tubs appearing to be weeds. Several staff in their surveys commented that the home needed to be redecorated. The interior of the home and the main exterior entrance appears shabby and uncared for. On previous occasions requirements have been made that the room on the top floor of no. 47 Dean Street should be accessible to residents as this is part of the communal space. On the day of the inspection the door was open but it is still being used to store confidential records and there is nothing in the room to indicate that residents do use it. Staff were seen to be using disposable gloves and aprons appropriately and the washing machine which was broken has been repaired. The home appeared clean on the day of the inspection but there were several areas where there were offensive odours. Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Lack of suitably trained staff in sufficient numbers means that individual residents needs are not always met. Residents are protected by the recruitment procedures. EVIDENCE: Currently there are two members of staff undertaking NVQ level 3 and one undertaking level 2. One member of staff who is undertaking NVQ felt that she had benefited from the work and had been able to discuss as part of the team ideas and put forward suggestions. The deputy manager is applying to undertake NVQ level 4 in care and feels that she has noticed some staff undertaking the NVQ qualification are questioning things more and showing more interest in specific aspects of care within the home. Relatives and staff on their surveys said that they felt there was not enough staff available. This was given as a reason why activities outside of the home are not undertaken on a regular basis. In addition to the residents living at the home two days of the week four clients attend the home for day care and for three days three attend. For the five days when day care clients are at the Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 20 home two staff are involved in picking them up and bringing them to the home and taking them back in the afternoon. Each journey takes one hour thirty minutes. This reduces the staffing levels and time which can be spent with residents of the home. The inspector was informed that one of the clients who attends for day care will not go out therefore staff have to remain in the home with this client at all times. From paperwork included on one file it was unclear as to whether one resident was funded for extra staffing and the inspector was informed that this was being looked at. It has been established that another resident is funded for extra staffing but the home has been unable to provide it. The deputy manager said that the registered person has agreed that extra staffing can be provided but they have been unable to recruit suitable staff. Some staff when offered posts have said that the salary is not enough some people who have applied have not been suitable. The registered person has also agreed that at night there can be one waking member of staff on duty and two members of staff sleeping in. However they have not been able to recruit to this waking night post. Recruitment paperwork was seen for six newly recruited staff and all the appropriate paperwork and checks were seen to be in place. Since the last inspection the only training which has taken place is some on epilepsy. Staff are dealing with behaviours which may become violent at times but they have received no Breakaway training or training in how to understand what some of the behaviour may be about and how to distract residents. Some records show that some residents use different types of communication aids but staff have received no training in meeting communication needs. A recommendation was made following the last inspection that all staff induction and foundation training be LADAF (Learning Disability Award Framework) accredited, this remains outstanding. Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The new management team at the home have introduced some positive changes but general poor management procedures in relation to finance, compromise the efficient day-to-day running of the home. There is no clear development plan or audit meaning that residents and their supporters are not consulted about their views of the home. Health and Safety at the home is poorly managed, placing residents and staff at risk. EVIDENCE: The registered manager and deputy have been in post since the beginning of the year. One deputy manager has left since the last inspection. The inspector was told that another deputy manager was to be recruited. The one survey Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 22 form received from a care manager said that there was a more open attitude within the home compared to the previous management. Some staff and relatives also commented positively about the new management of the home. From discussion it appears that there is often a delay in things, which involve finances, being undertaken. The inspector was informed that the home has a set amount available to spend each month on things for the home including food. This does not include fuel for vehicles. However apart from the purchase of food all other expenditure has to be agreed and permission sought in writing. There seems to be a delay in this being obtained but it is unclear as to why this is. Currently no quality assurance programme is in place within the home which means that residents and their supporters are not consulted about the running of the home. A previous member of staff at the home commented on the fact that she felt the wiring of the home may be unsafe as she had heard crackling noises. The deputy thought that this was due to water from the leaks getting into the electrics but they had now dried out. This has not been checked out by a qualified electrician but by one of the members of staff. The records supplied by the home indicate that the wiring was checked in August 2004. Stickers seen on some portable electrical equipment indicate that they were last tested in August 2004 rather than the recommended good practice annual check. There are not sufficient staff trained in first aid to ensure that one such trained member of staff is on each shift. It was noted, in the garden that a container of slug pellets had been left unattended. These were locked away at the inspector’s request. The fire records were seen and the fire alarms are not being tested weekly and staff have not received any fire safety training this year. An immediate requirement was issued in relation to this as it was, following the last inspection. A requirement was made following the last inspection that one of the window restrictors be adjusted to ensure that the window did not open too wide. This has been complied with but on this inspection it was noted that two further windows which have box structures below open widely as they do not have restrictors fitted this poses a threat to residents. Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 23 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 X 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 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 X 15 4 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 3 X 2 X 1 X X 1 X Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 24 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 YA12 Regulation 16 (2) (m) Requirement Timescale for action 30/07/06 2 YA17 13 (1) (b) 3 YA18 13 (4) (c) 4 YA18 12 (1) (a) You are required to consult with residents and ensure that their social interests are met and make arrangements for them to engage in meaningful activities. You must ensure that alternative 14/07/06 ways of seeking medical attention are found for the identified resident. You are required to ensure that a 21/07/06 risk assessment is in place in relation to feeding for the identified resident. You are required to ensure that 31/08/06 the welfare of service users is met in relation to their communication needs by all staff. (Previous timescale of 26/08/05 & 30/4/06 not met) You are required to ensure that the correct equipment is available to meet individual dietary needs. You are required to submit a redecoration programme with timescales to the CSCI. (Previous timescale of 03/4/06 not met) DS0000022048.V288946.R01.S.doc 5 YA18 23 (2) (n) 21/07/06 6 YA24 23 (2) (d) 14/07/06 Chantry Care Services Version 5.1 Page 25 7 YA24 23 (2) (b) You are required to ensure that the roof to the home is permanently repaired. You are required to ensure that broken and damaged tiles are repaired or replaced and that sealant around baths and washbasins is clean and intact. (Timescale of 31/12/05 & 02/04/06 not met) 31/08/06 8 YA24 23 (2) (b) 31/08/06 9 YA28 23 (2) (e) You must ensure that the first floor room in The Coach House is fully available for residents’ use at all times. (Timescale of 27/12/05 & 03/04/06 not met) You are required to ensure that all parts of the home are free from offensive odours. (Previous timescale of 2/04/06 not met) You are required to ensure that there are sufficient numbers of staff on duty both day and night to meet all residents’ needs. (Previous timescale of 01/04/06 not met) You are required to ensure that staff receive training appropriate to the work they are to perform. You are required to ensure that a regular review of the quality of care provided, which takes into account the views of residents and their representatives is undertaken. You are required to ensure that window restrictors are fitted to all windows above ground level. 21/07/06 10 YA30 16 (2) (k) 21/07/06 11 YA33 18 (1) (a) 21/07/06 12 13 YA35 YA39 18 (1) (c) 24 (1) 31/08/06 31/08/06 14 YA42 13 (4) (a) 21/07/06 15 YA42 13 (4) (c) You are required to ensure that 21/07/06 all chemicals hazardous to health are locked away when not in DS0000022048.V288946.R01.S.doc Version 5.1 Page 26 Chantry Care Services use. 16 YA42 23 (4)(d) You are required to ensure that all staff are up to date with their fire training and thereafter to receive training twice in a twelve-month period. (Previous timescale of 14/03/06 not met) You are required to ensure that fire safety checks are completed within the timescales. (Previous timescale of 03/03/06 not met) You are required to ensure that sufficient number of staff is on duty at all times who are trained in First Aid. 14/07/06 17 YA42 23 (4) (c) 14/07/06 18 YA42 13 (4) 14/07/06 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 YA6 Good Practice Recommendations It is recommended that more detail is included in care plans. 2. YA7 It is recommended that residents are offered more choice in their daily lives. 3 4 5 YA9 YA13 YA16 It is recommended that risk assessments individualised It is recommended that residents are involved more in community activities It is recommended that residents have unrestricted access to all communal areas of the home. DS0000022048.V288946.R01.S.doc Version 5.1 Page 27 Chantry Care Services 6 7 8 9 10 YA19 YA22 YA23 YA32 YA35 It is recommended that dates of healthcare checks are confirmed and up to date. It is recommended that all complaints are recorded. It is recommended that all staff receive by training or other means information in relation to Adult Protection. It is recommended that more staff undertake NVQ training. It is recommended that the induction and foundation training is LDAF accredited. It is recommended that the way in which day-to-day finance is made available be reviewed. 11 YA37 Chantry Care Services DS0000022048.V288946.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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