Inspection on 13/08/07 for Chargrove Lawn

This inspection was carried out on 13th August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chargrove Lawn 04/06/09

Chargrove Lawn 09/06/08

Chargrove Lawn 12/09/06

Chargrove Lawn 30/01/06

Chargrove Lawn 15/08/05

Chargrove Lawn 14/03/05

Chargrove Lawn 05/10/04

Chargrove Lawn 22/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Chargrove Lawn Shurdington Road Cheltenham Glos GL51 5XA Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 09:00 13th August 2007 X10015.doc Version 1.40 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 Chargrove Lawn DS0000016401.V341895.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 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. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chargrove Lawn Address Shurdington Road Cheltenham Glos GL51 5XA 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) 01242 862686 F/P 01242 862686 CTCH Ltd Mr Christopher Alan Whittington Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2006 Brief Description of the Service: Chargrove Lawn is a care home registered to provide personal care for 26 older people. In cases where nursing care is needed, it is accessed from community sources. The home is part of the CTCH Ltd group of homes and is set in a semi-rural location on the outskirts of Cheltenham. The home has been adapted from a large domestic residence and has two purpose built extensions. Single rooms are provided throughout. All rooms have en-suite toilets but eleven also have en-suite bathrooms. The home is arranged on two floors with a shaft lift providing access to the first floor. There is a large amount of communal space for residents use including three lounges, one of which includes the dining area, and there is a garden room adjacent to the hairdressing salon. A small room has been designated to provide an area where smoking is permitted. There are gardens to the side and rear of the property with patio area and garden furniture. A ramp allows easy access for people who use wheelchairs. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Chargrove Lawn range from £349.00 to £513.00 per week. Hairdressing, Chiropody, Newspapers, Toiletries and Transport are charged at individual extra costs. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this unannounced inspection over two days in August 2007. A check was made against the small number of requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of three residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents were spoken to directly in order to gauge their views and experiences of the services and care provided at Chargrove Lawn. Some of the staff were interviewed. Survey forms were also issued to a number of residents and visitors to complete and return to CSCI if they wished; a good response was received from residents, but with less from visitors, and some of their comments are featured in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Since the last inspection the home has made improvements to the resident call bell system, has purchased some new garden furniture for the residents, and has installed a new boiler. The home has also provided some new lounge furniture, which includes good quality armchairs of differing heights to suit different choices or abilities. The laundry room has undergone a refurbishment, and is now much more fit for its purpose. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 7 The recently implemented Smoking Regulations have been taken into account, and a designated smoking room is now provided which no longer impacts on the other lounges. The circumstances of a complaint that was received by CSCI earlier this year have been addressed, and feature in this report. The manager has introduced a new and improved format for recording and reporting any accidents that may occur. What they could do better: Although the care of residents is currently being carried out appropriately in terms of meeting their health and personal needs, the recording omissions and gaps in care plans are posing a degree of risk in this regard. Care plans have improved in many ways, and clearly are based on assessed needs, however more work is needed in this area. Staff must ensure that care plans are more meaningfully reviewed, with amendments and updates made to keep plans in use more relevant to the residents’ changing circumstances. More comprehensive risk assessments, which are robustly carried out are needed in some cases. The home is also required to share information appropriately with other agencies in certain circumstances such as when an unexplained injury occurs to a resident. A number of areas for improvement have also been identified in relation to how residents’ medications are administered and recorded. In consideration of the Fire Safety Order, the home’s Fire Risk assessment is not adequately robust, and there are some fire safety risk factors in the environment which have not been taken into account. As a consequence of this CSCI will refer this home to the Fire Safety Inspection Department for review. Many of the residents’ rooms and en-suite bathrooms were not very clean, and unpleasant odours were detected in some. Bed linen was crumpled and unironed, and beds were not made tidily, making some rooms appear more untidy generally. Chargrove Lawn offers the most minimum of staffing, particularly at night, and due to the apparently changing circumstances in the home staffing levels must now be thoroughly reviewed. The home has a most committed and enthusiastic manager who is actually intent on offering a good service to the residents and effecting improvements, however much more management focus is now necessary in the light of the numerous shortfalls identified on this occasion. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 8 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. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home are assessed prior to their admission so that they can be assured that the home will be able to meet their needs. EVIDENCE: Care records belonging to three of the more recently admitted residents contained assessment forms that identified their care needs prior to admission to the home. Although assessments had clearly been carried out, parts of these preadmission assessment forms contained very basic recording in some places. Assessments had evidently been carried out at locations convenient to the prospective resident, although in one case this had not been done directly in person due to the distance of the location, and were supported by information provided by other health and social care professionals previously involved in the care of the individual. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 11 Some of the residents and their relatives confirmed on surveys that the home was meeting their needs as had been agreed. The Group Care Manager confirmed that prospective residents should be receiving written confirmation of their placement at the home prior to their admission, as is required, but no direct evidence of this was seen on this occasion as records did not contain any copies. Chargrove Lawn does not provide intermediate care. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people living in this home do have their health and personal care needs met through largely satisfactory care delivery, the omissions in recorded care planning and medication systems are posing potential risks in this area. EVIDENCE: All residents have their own personal plan of care, which is based on a variety of assessments. Three were selected for a case tracking exercise, and were scrutinised in closer detail. Records contained evidence of resident involvement in devising and reviewing their care plan, and most aspects of the plans were subject to regular review, and were well written. Despite this, there were a number of recording gaps or no longer relevant points identified in some. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 13 In one case the resident’s continence needs were being met with the use of a catheter; although subsequent reviews showed that a continence pad was also in use this was not identified in the actual plan of care. Also, in consideration of the catheter it would have been appropriate to have a plan of care that included the importance of fluid intake to promote the patency of it, and a system to monitor the fluid intake and output; neither of these things were in place. The pressure sore vulnerability assessment showed this person was not at risk of developing a pressure sore. The fact that she had a large and debilitating dressing to her leg and her mobility was so poor posed some doubt as to the validity of the low risk score on this assessment; however, it should be reported that this person did not have a pressure sore. In the second case the care plan for the person’s dietary needs and poor appetite was not entirely relevant; among other things the care plan identified the need for a food monitoring record. Due to a recent improvement in relation to these particular circumstances the monitoring record was no longer in use, but the plan had not been amended and updated during review. This person, as with all others, had been regularly weighed, but a record of recent weights had not been kept in the care plan for four months. There was also a nutritional risk assessment in this case, which continued to identify her as being at high risk nutritionally. A falls risk assessment also identified her as being at high risk of falling. The associated care plan contained conflicting information, with one aspect identifying the need for one carer assistance, and another identifying the need for two. At some point it had been deemed necessary to introduce bed rails for this person; there was no documented risk assessment or plan of care to support this, and there was no evidence that their use had been consented to. This person’s pressure sore risk assessment had not been reviewed for four months, but showed her to be at a high level of risk in this area. Although appropriate equipment was in place to support her there was no specific plan of care to address this aspect of her care, with only a brief reference to the use of a mattress and cushion in a night time care plan. The community nurse was visiting this person regularly to carry out some wound management, which clearly contributed very significantly to her pressure sore risk factor. In the third care record there was frequent use of colloquial language and inappropriate phrasing, which could have compromised the person’s dignity had they read it. Despite this there was evidently some acknowledgement and acceptance of particular behaviours favoured by this person. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 14 A care plan to manage continence needs did not include any reference to the assessment and input of the continence specialist, despite this having been an important factor. There had been a referral to the Occupational Therapist, although there was no recording in any associated care plans to identify why this actually was. As with the first case, the pressure sore risk assessment showed no particular risk, and in consideration of this person’s particular physical circumstances there was a degree of doubt about the assessment outcome. Records demonstrated that residents are supported in terms of their health needs, with access to community health care services when appropriate. There were records of consultations with doctors, community nurses, chiropodists, dentists and opticians, and of hospital referrals. Residents themselves spoke very positively about the care they received in the home. The few relatives who responded to surveys also felt that the care their relative was receiving was of a good standard. Each felt that staff in the home sourced medical support for them appropriately. One person said that ‘they felt much better since coming into Chargrove Lawn’, with many spoken to in person saying that ‘the staff looked after them very well’. Residents are able to manage their own medications if they wish and are able, and two examples of this were seen being carried out on the basis of a documented risk assessment process. Storage for medications was generally safe, but due to the large amount of items in a variety of containers, the trolley was very full and not very tidy; this was in part due to two hospital discharges back to the home, with an excess of boxed and bottled supplies from the hospital pharmacy. Controlled Drug (CD) storage was provided, and a fully recorded and bound register was maintained; a short audit of items in this area was carried out, with no discrepancies identified. However none of the boxed items in use from the trolley had been dated on opening, making it impossible to conduct thorough audits in this area. A very small stock of items requiring cold storage was stored in the kitchen refrigerator, with appropriate temperatures for the items maintained therein. These items were stored within a locked metal box. Due to the conditions in the cold storage this box was beginning to show signs of rusting on the exterior surface, and was not considered to be the most hygienic method of storage and should be replaced with a more suitable alternative. The supplying pharmacist prints the medication administration charts. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 15 The receipt of medications was recorded on the charts, and a separate book of returned items was kept. Written protocols were in place for many of the medications that had been prescribed to be used ‘as necessary’, although some of these had been in place for a long time without any sign of a review. Hand written entries on medication administration charts were signed by the author, with a second signatory as witness. Variable dosages were identified in most cases. In one case, despite clear evidence from checking the monitored dosage pack that the items had been administered, a member of staff had not signed for having done so for all medication due on one specific date and time; this member of staff was identified from the rota, and the deputy manager resolved to address this with the person concerned. There was at least one other example of a similar failure. In another case at least three external treatments had not been administered in accordance with the doctor’s prescribed orders, apparently due to the resident’s refusal of them; there was no record that this was the case, merely signature boxes left blank. There was at least one other example of a similar failure also. There was an example of an external cream being prescribed to be used to ‘the affected areas’; although staff were aware of the need to apply this to dry skin patches, there was no recorded plan of care or protocol that contained any reference to this treatment at all. One person was receiving a variety of treatments to manage pain, and this was evidently under regular review and monitoring. However, one of the topical treatments for pain had only been administered twice each day, despite the prescription ordering it be administered three times each day. Staff were generally viewed as being sensitive and respectful towards the residents. Residents themselves confirmed that staff were always kind and helpful, and a random check on some quality surveys indicated that 100 of residents felt that staff were respectful to their wishes. A relative commented that ‘Mum always looks so happy and well groomed’. One resident said that some staff have told her she is very demanding, which although did not seem to bother the person or affect their appreciation of staff efforts, was viewed as being disrespectful and a compromise to her dignity. Care planning, the home’s policies, and staff training direct them towards respecting residents’ privacy and dignity at all times. Staff have received training in Care Values and Diversity training, which incorporated the principles of respect, dignity, privacy, choice, ways of life, diverse behaviour, independence and partnership. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have opportunities to exercise choice and maintain social contact, and also have a nutritious diet that offers choice and variety. EVIDENCE: Chargrove Lawn does not have a designated social activities coordinator, and all staff share responsibility in this area. Residents have been consulted about their past interests, hobbies, preferences and ideas for social activity, and records of activity and of those participating are kept. A social calendar is produced each month, which is displayed and also issued to each resident. This contains a variety of group activities and events. Some residents were pursuing personal interests, such as one with previous involvement with a local abbey, who was continuing to remain active with this in a number of ways. Another goes out regularly to attend a social club, whilst another pursues a particular interest in an alternative therapy clinic in the community. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 17 Two residents with sight impairments were supported to maintain some social and recreational interest, and were able to have a talking book, go for a walk, or receive the necessary support to join in group activity using other senses such as sound, touch and smell. Trips out are occasionally planned, and the home has the benefit of a wider community through social functions with other care homes in the group. Residents themselves spoke very positively about the social opportunities at Chargrove Lawn, with a small number saying they chose not to participate very often, and that this choice was respected. Despite a previous concern raised some time ago by a visitor that it was not always the case, assurances were heard from some relatives, staff and residents that visitors are free to visit at any time of theirs or their relative’s choosing. One visitor said that ‘the home fosters a friendly atmosphere’. Another said that ‘staff always let me know things, and keep me well informed’, whilst another confirmed that staff always made visitors very welcome. Many of the residents were moving around the home quite freely, whilst others were clearly more reliant on staff in this regard due to their higher dependency level. Those spoken to directly all confirmed that they could choose more or less ‘what they did and when they did it’. Visitor surveys indicated that in their view the residents were supported to live their lives as they chose, and that staff respected people’s differences and choices. Residents can shop for items themselves from a small choice of visiting retail opportunities available to them in the home. They can exercise personal choice in their rooms, and many have introduced some of their treasured items, making rooms appear more personalised. Staff were heard offering choices to residents in a variety of ways, one of which was with selecting meals from the menu. The service of breakfast and lunch was seen. Staff have listened to the wishes of some residents, and are trialling serving breakfast in the dining room for those who want it, rather than in their rooms. However, this is not without its problems, and breakfast seemed to be late in some cases, with staff appearing rushed and frustrated with delays. Meals served were varied according to choice, and each looked wholesome, nutritious and appetising; those requiring a special diet were catered for. Special eating aids were supplied where needed, and staff were in attendance in the dining room throughout the meal. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 18 One resident, who was having lunch in her room, had a pot of yoghurt on her tray for pudding; staff had not given consideration to the fact that she was unable to remove the foil lid of the pot, and needed help to do this. With just one exception, all residents spoken to said that they really enjoyed the food here. The cook was well informed about each individual’s dietary requirements, and demonstrated a commitment to providing residents with what they wanted. She said that staff informed her of any special requirements when residents were admitted, but that on very odd and isolated occasions important information was late coming through to her. Catering records were maintained, and the kitchen seemed reasonably orderly. The home has been working to address a number of concerns that were identified at an Environmental Health inspection earlier this year. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home feel reassured by the home’s complaints procedure, and despite an isolated concern, are protected against abuse and have their rights protected. EVIDENCE: Chargrove Lawn has a clearly written and displayed Complaints Procedure, a copy of which is provided to each prospective resident and/or relatives along with other information about the home. A complaints register is maintained, and this contains evidence of a regular audit, not that the home has had many concerns raised lately. The CSCI looked into the circumstances of one complaint in recent months, which involved the home’s failure to keep the family informed of their relative’s changing condition and care; it was clear that the findings of this had been taken seriously, with the appropriate actions taken to give staff the necessary instruction and direction as a consequence of the issues raised. Residents and visitors indicated they felt quite comfortable to raise concerns if they had any, confirming that the manager and staff were always receptive and helpful. One said that some were ‘better than others’. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 20 The deputy manager was witnessed helping a visitor with a concern, and clearly welcomed and appreciated the opportunity to provide a resolution and reassurances. The home provides documented policies to address forms of abuse and whistle blowing procedures, which are readily available for staff to read. A copy of the Department of Health ‘No Secrets’ document was also available, as was a copy of the recently introduced Mental Capacity Act. There are documented staff disciplinary procedures, and these have been instigated in one case in recent months. Adult protection and abuse issues are covered in the induction training programme, which each newly appointed member of staff attends, and all staff have attended specific adult protection training in the last year, with more planned. The manager and the deputy manager have attended specific training regarding the Mental Capacity Act, and it is now intended to cascade this to all staff using learning materials from the Local Authority. Staff spoken to confirmed their training in this area, and their awareness of related issues. One visitor commented that they ‘had complete confidence in the home’, and that ‘staff always put the interests of the residents first’. Accident records showed that one resident had sustained a bump and bruise to his hand, which although assessed at the time to have come from knocking his hand on a rail, was really unexplained due to the fact it was not witnessed, and the resident nor staff could be certain. No further action had been taken, and the incident was not shared with any other professionals at the time. A discussion took place about circumstances such as these, and advice was given about the responsibility incumbent on the home to act appropriately in such circumstances, by reporting them to the appropriate persons, and ensuring full documentation about them. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in this home are being placed at risk through failures to address fire safety in certain areas, and the poor standards of cleanliness currently being maintained. EVIDENCE: Chargrove Lawn is an older style property that has been extended, adapted and equipped to meet the needs of the residents living there. For the most part the environment is well maintained and decorated, and provides quite a homely and comfortable home. There is a designated maintenance team available to the home, and records of maintenance requests and of work undertaken were seen. Since the last inspection there is a new call bell system, boiler, lounge furniture with armchairs of differing heights to suit different abilities and preferences, Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 22 and garden furniture. The manager has more plans to upgrade the patio area outside. Due consideration has been paid to the recently implemented Smoking Regulations, with a designated room clearly identified. Assurances were given that a written statement has been produced regarding the home’s arrangements in this regard, as is required, but this was not seen on this occasion. Many doors leading into residents’ bedrooms were not fitted with intumescent strips as part of fire protection and smoke containment in the event of a fire, and this fact coupled with the inadequate fire safety risk assessment will now prompt a referral to the Fire Inspection Officer for a review following this inspection. The garden is large and well kept, and the front looks very attractive, with the home having won prizes for its beautiful floral displays. The rear garden has a small pond, and following a requirement to risk assess this feature, the home has produced a generic assessment, which goes onto prompt individual assessments for those residents using the garden. On this occasion there was so much accumulation of green surface weed, it was difficult to detect that this was even water, and although the pond is slightly raised off ground level could add to the risk. A large number of residents’ rooms were visited, and many of them were unclean, with en-suite bathrooms and toilets largely in a similar condition; many toilets were very dirty and stained, and the domestic style baths had accumulated dirt and other bits through non-usage, and odd items were lying haphazardly in the bottom. Carpets were marked and worn in some rooms. There had been no cleaner on this day, which would account for many carpets being littered with bits and the waste bins in each room not having been emptied, but the general standard of cleanliness throughout the rooms had clearly arisen over time. Unpleasant odours were very noticeable in some rooms. Staff had stacked items on unclean en-suite bathroom floors, such as packets of incontinence pads, gloves and aprons. There was a male urinal on the floor in one of the en-suite toilets belonging to a female resident; no-one could explain why this piece of equipment would be in there. The cistern lid in one toilet was not safely in place, having been left adrift, as with one of the bath panels in another room. The focal point of rooms was really the bed, with many detracting from this, as bedding was unironed and very untidy. The first floor bathroom was very dimly lit, and had been left untidily, with a bag of rubbish on the floor, among other things. The adjustable assisted bath Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 23 was dirty, with a build up of dirt and debris around the door seal, and there was a small floor standing shelf unit, which was covered with dust and dirt. First floor corridor lighting continues to be quite dim, despite recommendations to brighten this, and the carpet running outside rooms 23 to 28 was worn and marked. Coincidentally, one visitor survey had said that although the staff were kindness itself, the home needed to have more cleaning staff. The laundry room has been upgraded to provide a new washing machine that is capable of sluicing and disinfecting any infected laundry. Flooring in here has been replaced, new racked shelving has been fitted, and cupboard doors now repaired; altogether this room is now much more fit for purpose. The CSCI has been liaising with the Group Care Manager regarding the home’s management of clinical waste, and has given advice in this regard. The home does not have a contract for the collection of clinical waste and incontinence waste continues to be bagged for collection by the council. This reportedly goes to an appropriate landfill site, though the home has been advised that waste must be risk assessed for anything that may be infected, as this would require an alternative method of disposal. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 24 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home receive care from a competent workforce, which is recruited using robust pre-employment checks, but provision at certain times is very low and may pose risks to the way in which care is managed. EVIDENCE: The majority of residents and visitors felt that there was normally an adequate number of staff on duty to provide care for them, who were appropriately skilled and experienced. One said that ‘Staff were always to hand when needed’, whilst another said that ‘staff have a good knowledge of each resident’. Weekly staff rotas are maintained and demonstrate that there are three care staff on duty during all daytime hours. On five days of the week there is usually at least one if not two members of the management team working supernumerary to this number. However there are other non-care duties that detract from this care provision, such as carrying out laundry, catering for breakfast and supper, and doing some cleaning at weekends. For a very long time now the night arrangements have been just one waking carer and one sleep-in carer, who can be called upon to help if needed. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 25 Minutes of staff meetings identified that this was causing slight problems now, with staff instructed to tell residents, when they are experiencing delays going to bed at night, that there is only one member of staff on duty. This is not acceptable if the second staff member is not available to help, and if the current very low and basic provision of staff is not meeting the needs of the twenty-six residents. These circumstances must be reviewed, particularly in the light of the Fire Safety Order, which would require at least a phased evacuation in an emergency. The home has made good progress with the National Vocational Qualification (NVQ) training programme for care staff. There were nine care staff qualified to at least level 2 at this time, with a further three currently on a course to achieve their award. One senior carer has the NVQ Mentorship award. Personnel files relating to three members of staff who had been recruited in recent months were inspected. In each instance, the prospective employee had completed an application form providing details of their employment history. Two written references had been provided in each case, including one from the last employer. In one case the way one of these references had been written posed some doubt as to its authenticity, however the manager had been able to confirm the validity of it at the time of receipt. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. Where deemed necessary, risk assessment regarding the employment of staff under certain circumstances had been carried out. The General Social Care Council Code of Conduct for care workers had been issued to each member of the care staff. New staff are inducted to the home, and are assessed initially to determine their knowledge, experience and competence, so as to determine the level of training required. Most attend a structured induction with an external training provider, the content of which is in accordance with the Common Induction Training Standards for care workers. In addition to this, plus for any others, they work through an in-house induction programme that is specific to the home itself. Training records for this were seen, and each is allocated to a supervisor for their induction period. As part of ongoing staff development there is a programme of training available to them, some of which is mandatory. A training matrix and training certificates contained in records confirm that topics are entirely relevant to the work they perform. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 26 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at this home feel reassured by the open, accessible and respectful management, but much more focus is needed in terms of effecting improvements regarding the safety of the environment for them. EVIDENCE: The manager at Chargrove Lawn is experienced in the care of older people in similar settings, and has been registered with CSCI for his role. He has achieved his Registered Manager’s Award, and is currently studying for his NVQ level 4 in Care. One relative said that ‘the home offered good value for money’, whilst another said that ‘the home continues to make improvements under the manager’. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 27 It is certainly appropriate to report that the manager has worked very hard since coming to Chargrove Lawn, is enthusiastic about his work and the care of the residents. He adopts a clear intention to effect improvements, and has made positive strides in many areas. He has also demonstrated an openness and cooperation towards working with other agencies, such as CSCI. However, following this inspection there are some areas that will require a significantly increased degree of management focus if they are to improve. Residents have been consulted about their ideas and views for the home, either through organised meetings or using survey questionnaires. Their families and friends are also encouraged to participate and contribute to the life of the home, and the manager and his deputy remain accessible and approachable to all. The home plans to introduce quality assessment surveys to visiting health professionals in the future also. A large number of residents have placed personal money with the home for safekeeping. Clear and detailed records for each person, which include transaction details, running totals, and receipts are kept. Residents or their representative are able to have access to their individual record, and periodically a photocopy is supplied to them in the interests of openness and transparency. Two staff members sign the record to witness any transaction carried out at the request of the resident, and on their behalf. Receipts for transactions are kept in each case. Regular audits are carried out on these arrangements. Staff attend mandatory health and safety and fire safety training. They have been assessed regarding their fire safety awareness competency, and training is provided accordingly. There was no record of the content of fire safety training, so it was difficult to determine the robustness of this. A record of fire drills had been maintained. Evacuation procedures had not been practised, either during the day or night, and further to issues reported under standard 19 above regarding the Fire Risk Assessment, a referral will now be made to the Fire Inspection Officers. The fire alarm panel, smoke detectors and extinguishers have been checked and maintained, and weekly and monthly checks are carried out on the fire alarm and emergency lights respectively. Records were provided to show that statutory maintenance/inspection of equipment and services is arranged in a timely fashion. Regular checks are conducted on the hot water in order to maintain safe temperatures for the residents, and the proprietor has previously confirmed that Legionella control measures are through the necessary storage and distribution temperatures. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 28 The home has first aid facilities, and all staff have received some first aid training. A discussion took place around risk assessing the most appropriate level of first aid training for the needs of the home, and the Group Care Manager already has this under consideration. The manager has devised new and improved accident records, which are more comprehensive and allow for recording regular observations and monitoring over a twenty-four hour period after the event. The accident records also include reference to informing appropriate personnel of events, such as in the case of any family, which is an issue reported above under standard 16 with regards to a complaint. Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 29 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15(1) (2) (b.c) Requirement Timescale for action 30/09/07 2 OP8 13(4c) 12(2) 3 OP8 12(1b) 13(4c) 4 OP9 13(2) All care plans must be written to address and meet each assessed need, and must be subject to a full review and be revised accordingly, so that residents’ care needs can be met appropriately for their health and wellbeing. Staff must conduct and record a 30/09/07 risk assessment when considering the use of bed rails, and when assessed as appropriate must obtain the resident’s consent for their use. This is to ensure that any risk posed by the use of the rails to the residents can be minimised or removed. The manager must ensure that 31/10/07 each resident’s pressure sore risk assessment is thoroughly reviewed, so as to ensure that any risks in this area are clearly identified and the appropriate actions can be taken. When boxed medications are 30/09/07 opened for use staff must write the date clearly on the box so as to make it possible to conduct DS0000016401.V341895.R01.S.doc Version 5.2 Chargrove Lawn Page 31 5 OP9 13(2) 17(1a) 6 OP18 37(1.2) 7 OP26 16(j.k) 8 OP26 13(3) 9 OP27 18(1a) audits on the medication used. This is in order to evidence that residents are receiving their medication as prescribed. When medication is administered to people who live in the home it must be clearly and accurately recorded and given in accordance with the doctor’s directions. There must be up to date medicine care plans or protocols to clearly describe how to use any topical medicines prescribed to use ‘to the affected area’. This will help to make sure people receive the correct levels of medication. The manager must ensure that any unexplained injury sustained by a resident is reported to CSCI without delay. Residents’ rooms and en-suite bathrooms must be thoroughly cleaned and then maintained in an hygienic and odour free state. Hygiene supplies for use with residents such as gloves, aprons and continence pads must not be stored on the floor of en-suite bathrooms, as this is unhygienic and is posing an infection control risk. A full review of the levels of staffing at all times of the day and night must be undertaken, with sufficient staff provided to ensure residents’ safety and that their needs are met appropriately. 30/09/07 30/09/07 31/10/07 31/08/07 30/11/07 Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 32 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 OP8 OP7 OP9 Good Practice Recommendations The fluid intake and output of residents who are catheterised should be monitored. The staff use of colloquialisms in residents’ care records should be avoided. • Staff should ensure that the medication trolley is maintained in a clean and tidy condition • The metal box used for cold storage of certain medications should be replaced with a more suitable alternative • Medication protocols should be kept under more regular review. The level of first floor bathroom and corridor lighting should be made brighter. The home should be making efforts to return bed linen to rooms in an ironed and orderly state. There should be an increase in the amount of ancillary workers to reduce the added non-care duties placed upon care workers. The content of fire safety training should be recorded. 4 5 6 7 OP19 OP26 OP27 OP38 Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Chargrove Lawn DS0000016401.V341895.R01.S.doc Version 5.2 Page 34 - 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. 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