CARE HOMES FOR OLDER PEOPLE
Chardwood 127 Eastbourne Road Pevensey Bay East Sussex BN24 6BN Lead Inspector
Angela Gunning Announced 18 July 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Chardwood Address 127 Eastbourne Road Pevensey Bay East Sussex BN24 6BN 01323 766058 01323 760983 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) Mr Roland Richardson Mrs Mary Richardson Mr Ashley Richardson Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (OP) 15 of places Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of service users to be accommodated is fifteen (15). 2. Service users will be aged sixty-five (65) years or over on admission. Date of last inspection 6 December 2004 Brief Description of the Service: Chardwood is a care home for fifteen (15) older people. The home is within walking distance of the beach, half a mile from the village of Pevensey Bay and approxiamatetly 4 miles from the town of Eastbourne. The home provides thirteen (13) single rooms, eleven (11) with ensuite toilet and hand basin facilites and one shared room. There are two assisted baths and one assisted shower facility. The home provides several communal areas, including a conservatory, a dining room,a lounge and and a patio area in the garden. There is a passenger lift to access the first floor accommodation. Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection, which was undertaken over five hours during the day. Parts of the environment were inspected, including all communal areas, the kitchen and some bedrooms. Three care plans and two staff files were examined. Several people were spoken to on the day of the inspection, including the manager, two members of staff, five residents and one relative. What the service does well: What has improved since the last inspection?
The manager has implemented all the health and safety requirements from the previous reports, which includes installing thermostatic control valves on all hot water outlets to prevent people scalding themselves. Moving and handling guidelines for using mobility equipment have been developed to ensure residents and staff safety. The manager has organised various activities within the home, such as arts and craft sessions, bingo and quizzes. One resident said ‘I like the quiz, but I mustn’t boast but I come up top’. It is noted that the manager is being proactive in identifying training needs for staff and a new induction programme has been developed which new staff are currently working through. Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 5 The home’s Statement of Purpose and Service User Guide provide prospective residents and their relatives with adequate information to enable them to make an informed choice. There is a comprehensive admissions procedure in place to assess the needs of people prior to them moving into the home. EVIDENCE: The manager informed the Inspector that prospective residents are given a copy of the home’s Statement of Purpose and a copy of the home’s Service User Guide is given to them when they move in. Residents spoken to during the inspection confirmed that they have been given the necessary information. A contract of residency is given to residents and their relatives four weeks after moving in. One resident said ‘I chose to come here and I never regretted it for a minute’. A comprehensive proforma is used for recording prospective residents health and welfare needs to determine if the home can meet their needs. Since the last inspection six people have moved into Chardwood and a pre-admission assessment had been carried out before they moved in, to ensure that the home could meet their physical, emotional and social needs. One resident said that ‘I came in for a week and have been here ever since, because I liked it so much’.
Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The home has an effective care planning system to monitor the health and welfare of residents. Medication arrangements in the home are well managed to ensure resident’s medication needs are met. The privacy and dignity of residents is respected. EVIDENCE: The care planning system provides staff with the information they need to meet residents’ health care needs and one resident commented that ‘staff are very helpful’. Risk assessments that assist to minimise hazards and risks around the home and in residents bedrooms are carried out on a regular basis. There are assessments and guidelines for moving and handling residents and care plans are reviewed by the manager and staff on a monthly basis. There is documentary evidence of good liaison with various health care professionals. The administration of medication observed during the lunchtime meal was carried out appropriately. It was noted that five members of staff have almost completed a 12 week training course on the safe handling of medication. Medication requirements are clearly documented in each residents’ care plan and GPs are consulted when necessary. It was noted that a pharmacist has not carried a monitoring visit to ensure that the correct procedures for the storage,
Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 10 recording and administration is being carried out and the manager confirmed that he would request that one is carried out as soon as possible. The manager and staff were observed to interact and speak to residents in a friendly and respectful manner. One resident spoken to said that ‘everyone here is very kind’ and another man said ‘the people who look after us are very good, you couldn’t wish for better people’. The newly developed staff induction training programme guides staff in how to assist residents in maintaining independence, privacy and dignity. Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14, 15 The arrangements for leisure and social activities inside and outside the home provide good opportunity for mental and physical stimulation and promote independence and choice. There is a well-balanced and varied menu that meets residents’ dietary needs. EVIDENCE: Residents are encouraged and supported to maintain links with the community and contact with family and friends, to ensure their independence and social well-being is promoted. During the inspection one resident went to her weekly luncheon club and another went out with her husband, who informed the Inspector that he ‘can visit when he likes and has lunch at the home every Sunday’ and is ‘very pleased’ with the care his wife is getting. The manager organises various activities within the home, such as arts and craft sessions, bingo and quizzes. One resident said ‘I like the quiz, but I mustn’t boast but I come up top’. The home provides a weekly menu, which is changed every four weeks and the manager confirmed that the menu is also changed seasonally. Meetings are held with the residents to discuss the choice of meals. One resident considers that ‘the food is lovely’ and another that ‘the food is first class’. Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 There is a satisfactory complaints system in place to ensure residents views and concerns are listen to an acted upon. There are adequate arrangements for ensuring residents are protected from abuse. EVIDENCE: The home has a complaints procedure, which is accessible to residents and their relatives or representatives. There is a book for recording concerns or complaints and the action taken to deal with them. The manager has developed an adult protection policy and procedure, which reflects local multi-agency guidance on protecting vulnerable adults. Some staff have received training in adult protection and prevention of abuse and the manager confirmed that he will be attending a training course in October and will cascade the information received in the home to ensure that all staff have this information. Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 25, 26 Chardwood offers a safe, clean and comfortable environment, with sufficient environmental adaptation and equipment to meet residents’ needs. EVIDENCE: The home was seen to be kept clean and tidy, with all communal and private rooms decorated and furnished to a good standard. Bedrooms are personalised and residents confirmed that they are able to bring in their own furniture. The home provides a passenger lift to access all private and communal areas in the home, which was in working order. There is a call bell system throughout the home. There are two bathrooms and a shower room, with assisted bath seats. It was noted that there is no storage facilities for towels and incontinence pads, making these areas appear cluttered and not homely. Hold open safety devices have been fitted to doors in the communal areas and on residents bedroom doors, where they request these to be left open. The home now has non-smoking policy and staff and residents smoke outside in
Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 14 the patio area. Hot water outlets are fitted with safety valves to prevent residents scalding themselves. However, it is advised that the home maintain regular recorded checks of water temperatures. Most radiators are fitted with guards and where not, a risk assessment has been carried out to prevent residents burning themselves on hot surfaces. Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 There is a competent and stable staff team who ensure residents needs are met. The recruitment, induction and training of staff offers protection to the residents living at the home. EVIDENCE: At the time of the inspection there were fourteen (14) residents living at Chardwood and the staff rota indicated that there are two care staff on duty during the day and one waking night staff. The home employ two cooks and a cleaner. Staff receive both in-house and external training in various aspects of care, to enable them to perform their job appropriately. It is noted that the manager is being proactive in identifying training needs for staff. New staff are currently working through the home’s new induction programme. Chardwood has a good retention of staff and one member of staff considers that ‘residents are well looked after’ and the home ‘has a good staff team’. One resident said that ‘staff are always willing to help’ and that ‘you couldn’t wish for better people’. Recruitment files were checked and these were seen to contain the relevant information, including Criminal Records Bureau (Check) checks. Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 36, 37, 38 The management structure is being developed to ensure there is clear leadership at all times. There good arrangements in place to meet residents’ health, safety and welfare needs at all times. EVIDENCE: The manager has been working in this family run care home for many years and has been managing the home for over three years. He has achieved the Registered Managers Award and a National Vocational Qualification Level 4 in Care. He informed the Inspector that he intends to develop a clearer management structure by promoting a member of staff to be his deputy. Staff receive regular one to one supervision sessions and one member of staff confirmed that she could talk with the manager at any time. Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 17 Records of financial transactions carried out for residents were checked and found to be satisfactory. A record of possessions brought into the home is maintained for each resident. The manager has implemented all previous inspection requirements regarding the health and safety of the premises. One resident spoken to said ‘I couldn’t wish for a better place’ and another said ‘I couldn’t praise this place more’. Chardwood H59-H10 S21070 Chardwood V228117 180705 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 Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 x x 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x 3 3 3 3 Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 19 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. 2. Standard 18 Regulation 13(6) Requirement That all staff receive training in prevention and protection of adult abuse. Timescale for action 30/11/05 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. 3. Refer to Standard 25 9 21 Good Practice Recommendations That the home maintain regular recorded checks of hot water temperatures. That a pharmacist carries out a monitoring visit to ensure that the correct procedures for the storage, recording and administration is being carried out. That storage facilities are provided for bathroom towels and incontinence pads. Chardwood H59-H10 S21070 Chardwood V228117 180705 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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