This inspection was carried out on 25th July 2005.
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 4 statutory requirements (actions the home must comply with) as a result of this inspection.
CARE HOME ADULTS 18-65
The Chantry 46 Dean Street Crediton Devon EX17 3EN Lead Inspector
Susan Lyons Announced 25 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Chantry Address 46 Dean Street, Crediton, Devon, EX17 3EN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01363 772301 01363 772348 Chantry Care Services Hayley Phillips Care Home 11 Category(ies) of LD: Learning Disability 11 registration, with number PD: Physical Disability 4 of places The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The manager must obtain the Registered Managers Award by 2006 Date of last inspection 11 September 2004 Brief Description of the Service: The Chantry is a ‘listed’ building close to the centre of Crediton. The premises are two-storey and detached. The large gardens include a workshop, animal enclosures, and a new outdoor swimming pool (-enclosed and built above ground level). There is some private parking. The home offers accomodation and care to eleven service users with learning disabilities. There are a lounge, 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. There is one adapted bathroom, one hoist and a ramp to the Home’s back door. 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 marked transport. Vegetables and fruits grown in the garden by clients and staff are used at the Home. The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over two days and lasted for approximately five hours. The methods used were; Discussion with service users and staff Discussion with the Registered Manager A completed pre inspection questionnaire Study of paperwork and records within the home. Four service users were case tracked and their care plans studied. What the service does well: What has improved since the last inspection?
Since the last inspection staff have received information in relation to the Protection of Vulnerable Adults. A new manager has been registered with the Commission. A statement of confidentiality has been given to partner agencies. Over the counter/homely remedies are now recorded on the medication sheets. The
The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 6 complaints procedure has been rewritten The shower tray has been replaced and soap and hand drying facilities are available in the laundry. Staff are now identified on the rota. 1 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 8 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 standard(s) 2,3 & 5 In-house assessments ensure that service users needs are recognised. Inconsistent practice is limiting the ability of some service users. The Statement of Terms and Conditions does not provide adequate information to ensure that service users are aware of their rights. EVIDENCE: Assessments were seen for service users who were case tracked. In some cases these were shared assessments. All service users had assessments, which have been completed, within the home. It was noted that a member of staff was unsure about how to use a specialist form of communication used by one service user. A second member of staff was able to describe the way in which the system should be used. Statement of Terms and Conditions of Residence need to be updated. The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 9 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 standard(s) 6 & 9 There is clear and consistent care planning in place to adequately provide staff with the information they need to meet service users needs. Service users would benefit from being involved in this process. Risk assessments identify and minimise risk to service users. EVIDENCE: Currently the home is in the process of up dating the individual care plans. Three of the care plans, seen have been updated and contain the information required in sufficient detail to ensure that service users individual needs are met. The fourth care plan, although not yet updated, does have some good information contained within it. Care Plans contain behaviour management plans where required. It was not possible to ascertain from service users that they knew about their own care plans but a member of staff said that they do talk to the service user when the care plan is being reviewed, however they are not always interested. There is no recording of when this has happened. Evidence was seen that the care plans are being reviewed monthly. Risk assessments were seen for individual service users. They cover identified risks both within the home and the larger community.
The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 10 The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 11 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 standard(s) 13, 14 & 17 Leisure activities and community access provide interest for service users. The meals in the home offer both choice and variety. EVIDENCE: Service users make use of local community facilities including shopping, swimming and playing skittles. They attend a coffee morning at the local church and visit some tearooms as well as having meals out and playing skittles at an Inn. They also go out for walks and rides. Within the home there is evidence of games puzzles and books being available for service users. Staff say that meals are discussed in the service users meetings and service users help with the food shopping. Food provided is recorded and the main meal of the day is now eaten at midday rather than the evening. The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 12 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 standard(s) 18, 19 & 20 The recording of individual preferences ensures that service users needs are met in a way in which they prefer. Emotional and physical health needs are met with service users being supported by medical professionals. Systems are in place to provide safe administration of medication to service users. EVIDENCE: Currently only one service user requires some assistance with mobility and staff confirmed that they have been shown how to do this by the physiotherapist. Details of personal care needs are detailed in individual care plans. Male staff do not attend to the personal care of the female service users. All service users are registered with a GP and attend regular dental and optical appointments. Weight is monitored and recorded on a monthly basis. Additional support is obtained from external health professionals on a regular basis. The medication is stored in a metal cupboard and is provided in a monitored dosage system from a local pharmacy. Staff have received training from the pharmacy. Recording was seen to be completed but where changes have been made to medication this must be signed by two members of staff. The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 13 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 standard(s) 22 & 23 Adequate Complaints and Adult Protection procedures protect service users. EVIDENCE: A complaints procedure is available on display in the hall of the home and it is also available in symbols. It was difficult to ascertain whether service users understood about who to speak to if they were unhappy but one service user named a member of staff he would go to. During the past twelve months the home has recorded three complaints two of which were substantiated and one which was partially substantiated. Staff have watched the ‘No Secrets’ video and answered appropriately when asked what they would do if they felt a service user was being treated inappropriately. Staff said that the topic is regularly discussed in staff meetings. The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 14 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 standard(s) 24 & 25 The home is generally comfortable but there are two areas which require attention. EVIDENCE: On the day of the inspection the home was clean and tidy but also looked ’lived in’. Service users confirmed that they are able to furnish their rooms with their own possessions and help choose the colours. It was noted that one area of wall in the corridor requires repairing and an aerial lead was under the carpet in one bedroom potentially presenting a risk of fire. Furniture is domestic in nature and there is nothing to distinguish the home as a residential one. The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 35 Staffing levels meet the needs of current service users. Improvements are needed in staff training to ensure that service users needs are met. Recruitment practices in place protect service users. EVIDENCE: The home has service users in the home for day care during the week and currently the staffing levels meet the needs of the all the service users. One service user is funded for one to one care and the staffing levels indicate that this is also being met. Currently the home is using videos to train staff in the statutory training. They are undertaking this all in one-day. Whilst this would be an acceptable method for induction of staff it is not sufficient to meet the needs of staff beyond induction. To undertake several different subjects in one day is not an effective way of training staff. Recruitment practices in place protect service users and they benefit from wellsupervised staff. Service users do not benefit from staff receiving specialist training. The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 & 42 Service users benefit from the completed self-monitoring, review and development programme. Service users safety is compromised by lack of fire safety checks and training for staff and the inappropriate use of a fire door. EVIDENCE: A quality assurance programme was completed and a brief report completed. The manager said that a new quality assurance programme is being undertaken by the larger organisation. Fire records indicate that there have been periods of time when the fire alarms have not been tested weekly, the most recent time being between 3rd June 2005 to 4th July 2005. The manager said that she has now made a member of staff responsible for undertaking all the fire safety checks and the training. Some staff have not received fire safety training twice in a twelve-month period. The door to the study has a devise fitted to the bottom so that it can stay open but will close automatically when the fire alarms are sounded. This devise has damaged the floor and is now not working correctly . The door has
The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 17 been held open by a chair and will therefore not close in the event of a fire. An immediate requirement notice was issued in relation to this. The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 1 x 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 x x x x x Standard No 11 12 13 14 15 16 17 x x 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x x 3 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Chantry Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 1 x D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 19 No 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 YA3 Regulation 12 (1) (a) Requirement You are required to ensure that the welfare of service users is met in relation to their communication needs by all staff. You should ensure that all members of staff receive fire safety training twice in a twelve month period. You are required to ensure that fire doors are kept shut unless fitted with a closure which will react to the fire alarms You are required to ensure that fire safety checks are completed within the timescales. Timescale for action 26-8-05 2. YA42 23 (4) (d) 26-8-05 3. YA42 23 (4) (a) 27-7-05 4. 5. YA42 23 (4) (c) 26-8-05 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. 2. Refer to Standard YA5 YA6 Good Practice Recommendations It is recommended that the Statement of Terms & Conditions are updated It is recommended that evidence of service user involvement in the completion and review of care plans is
D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 20 The Chantry 3. 4. 5. 6. YA20 YA24 YA24 YA35 available It is recommended that two staff sign documentation in relation to changes in medication. It is recommended that the ariel cable is removed from under the carpet It is recommended that the wall in the corridor is repaired It is recommended that statutory training beyond induction is more in depth The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Suite 1, 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. Extracts may not be used or reproduced without the express permission of CSCI The Chantry D54-D06 S22048 Chantry V225738 250705 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
