Inspection on 04/06/09 for Chargrove Lawn

This inspection was carried out on 4th June 2009.

CQC found this care home to be providing an Adequate service.

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 09/06/08

Chargrove Lawn 13/08/07

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 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Chargrove Lawn Shurdington Road Cheltenham Glos GL51 4XA Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 4th June 2009 08:30 DS0000016401.V375543.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chargrove Lawn Address Shurdington Road Cheltenham Glos GL51 4XA 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 01242 862686 CTCH Ltd Mrs Christine Mary Martin Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 26 9th June 2008 Date of last inspection 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, with a minimum of an en-suite toilet. 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 £490.00 to £544.00 per week, and the home also provides care at the basic Local Authority rate of funding where applicable. Hairdressing, Chiropody, Opticians, Newspapers, Toiletries and Transport are charged at individual extra costs. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience Adequate quality outcomes. 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 Regulatory Inspector carried out this inspection over one full day in June 2009. Care records were inspected with the care of four residents being closely looked at in particular. We also inspected the management of residents’ medications. A number of residents and a relative 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 over a third of residents and staff, with four sent to visiting health care professionals to complete and return to us if they wished. Half of the residents we surveyed responded to us, whilst a smaller percentage of staff and healthcare professionals responded. Some of their comments feature 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, provision, training and supervision 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, and the maintenance and cleanliness of the premises. We required an Annual Quality Assurance Assessment AQAA from the home, which was provided; the contents of this informed part of this inspection. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 6 What the service does well: Chargrove Lawn provides a welcoming atmosphere for visitors. People are admitted here following an assessment of their particular needs, and have a personal plan of care drawn up in consultation with them regarding the care that they need. In the main residents’ care plans are designed to meet needs and direct care, with residents receiving support and treatments when necessary from community health care sources. We saw some good examples of care and support being given to residents, and people generally spoke positively about their care and the way in which staff looked after them. Where possible, residents were able to manage their own medications. Residents’ families and friends are encouraged to join in the life of the home, and residents can maintain their outside interests and contacts as well. Families are also able to remain involved in the care of their relative residing in the home if this is wanted. The diversity amongst residents is respected, and they are supported to make personal choices. The arrangements to safeguard the interests of the residents are generally satisfactory, however the involvement of the local adult protection unit should be sought at the initial stage of when concerns of this nature arise in the future. Staff receive training that is suitable and necessary for their roles, and recruitment procedures are generally sound, although in one particular case the home should have ensured that the worker’s past dates of employment were much more precise. What has improved since the last inspection? The most significant improvement this home has made on this occasion is the appointment of a new manager, who has the experience and commitment necessary to equip him for the role. The manager has been consulting with staff and residents, and is identifying priorities for his attention and for improvement. There is already a growing confidence in the management to address concerns amongst residents. Aspects of the gardens have been enhanced, and some new garden and internal furniture has been provided. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 7 What they could do better: Information about the home should be given to interested parties and prospective residents much sooner in the pre-admission process so that they can have access to sufficient information on which to base their choice about moving here. Care staff are reliant on the new manager, and seem to lack confidence. They will benefit from increased guidance and support regarding their recognition of residents’ changing needs, which the new manager is able and plans to provide. Although there are some good examples of documented care planning there are some aspects that could be improved upon if all aspects of residents’ care are to be made completely clear for staff to follow. There are aspects of medication management that must be improved in order to protect residents, and overall the auditing arrangements in this area must be more robust. Although staff are generally respectful towards residents, there have been occasions when their behaviour has impacted negatively on residents’ dignity. A review of the content and delivery of the social activity programme is necessary in order to increase opportunities for residents in this aspect of their lives. Although there were some more satisfactory aspects of catering, with residents commenting positively in the main regarding the meals provided for them, there were some areas requiring improvement in relation to quality of the food and hygiene standards in the kitchen. On the surface there is a pleasant environment for residents, however closer inspection has shown that aspects of it are poorly cleaned and maintained. Improvements are now required, particularly in relation to the standards of cleanliness and hygiene. The absolute minimum of staff is provided here in all areas, and a complete review of these arrangements is now required. The AQAA information supplied to The Care Quality Commission (CQC) by the previous manager transpired to be unreliable and inaccurate in certain parts; the newly appointed manager must remain mindful of this when next completing an AQAA for this service. The service is required to provide us with a written Improvement Plan to demonstrate how they intend to carry out the necessary improvements here. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Chargrove Lawn DS0000016401.V375543.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.V375543.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A pre-admission assessment provides prospective residents with an assurance that their needs can be met at the home, but the failure to provide an information brochure in advance may hinder some people in making an informed choice about the home. EVIDENCE: The home’s AQAA told us that the information brochure (service user guide) was currently under review, and that a copy of it was issued to all residents. It also told us that everyone had access to read the latest copy of the home’s inspection report. An acceptance letter had been issued after the successful pre-admission assessment, and this indicated that the information brochure had been issued Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 11 just prior to the admission taking place. We considered this to be far too late in the process. Any prospective residents or interested parties must be given an information brochure at the point of enquiry, well in advance of admission, in order that they can use the information to assist them in making their minds up about the home and whether they would want to move in here. We inspected an example of a pre-admission assessment, which was for a resident more recently admitted to the home. The assessment had been carried out prior to admission being agreed and had been recorded on the home’s designated tool for the purpose. The assessment took account of the resident’s personal details, and their past medical history, their health and care needs, their medications, and health and safety aspects. It showed that the person’s next of kin had been present during the assessment process. We observed the manager showing a prospective resident’s representative around the home in order that they might view the facilities and learn about what the home had to offer. The manager had a very open, helpful and informative approach. One resident told us that her son had ‘come to look around on her behalf’, and that she had ‘no regrets about choosing it and coming in here’. Another told us that their daughter had viewed the home, and chose it because ‘it was the nicest amongst many that she had viewed’. Chargrove Lawn does not provide intermediate care. Chargrove Lawn DS0000016401.V375543.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 10 & 11. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can expect to have their needs met, although greater consistency is needed to maintain people’s dignity at all times, and towards improving the management of medications, as there is currently a degree of risk posed to people’s health and safety in this area. EVIDENCE: Each resident had their own care plan that had been drawn up on the basis of their assessed needs. They had been kept under review, and one resident told us that staff had discussed his plan of care with him, and that he had been involved in devising it. We chose four to case track and inspect more closely, largely on the basis of notifications we had received about them, or on the basis that aspects of their care had been raised with us through the home’s complaints’ procedure. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 13 Risk assessments were in place to address any wandering habit, falls, vulnerability to developing pressure sores, and nutrition. Care plans had been devised to address such areas. In one case the plan of care to address their wandering tendency was reflective of the resident’s preferred habits and behaviours. In another case however, where certain behavioural issues were apparent, the care plan was not fully reflective of the person’s behaviour and tendencies, and should have been more fully considered and recorded in this case. People’s choices and levels of independence were accounted for. In cases where a vulnerability to developing pressure sores had been assessed, the home had involved the Community Nurse, with pressure relief support introduced accordingly. A community loan hoist had also been provided in this case to address their particular moving and handling needs. This resident was currently in poor health and the General Practitioner had been called to assess and provide suitable treatment. The resident was experiencing some pain, and this too required management that was ongoing; the manager told us that a specific care plan was being devised to address this now. Despite being assessed as low risk nutritionally this person had lost weight in recent months, and staff were reportedly encouraging their diet. However in the absence of staff maintaining a diet and fluid monitoring record it was not possible to assess how the person’s dietary and fluid intake was progressing, if at all. The manager agreed that this should have been implemented already by this stage, and agreed that he had identified since starting here that staff required more guidance in relation to recognition of residents’ changing or deteriorating needs. This person’s next of kin was recorded as assisting them with their decision making processes. In another case the Community Nurse was involved in some wound management, maintaining her own health related records for the resident concerned. A specific care plan to direct the care staff had not been devised in the home, although we saw a record of the Community Nurse’s involvement, which had not been updated for over two months. In another case there had been extensive medical input for the person’s particular medical condition. There was some good risk management for their risk of falls and impaired mobility, which also incorporated the use and effects of their medications. This person’s partner was also very involved in their care, which was their particular choice. This person and their partner told us that staff were very mindful and respectful towards this arrangement. This person had lost some weight also according to recent weight monitoring. Daily records were largely just tick lists in many cases, confirming that care had been delivered in accordance with specific care plans on a particular day. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 14 However, any supplementary comments had been added in places, which was much more helpful to see. Residents were enabled to manage their own medications if they wished, although individuals’ wishes with regards to this were not actually recorded anywhere. One person who had made a choice to deal with his own had been provided with a lockable drawer for his medications, and a risk assessment to support the arrangement was in place. Storage arrangements for medications were satisfactory, and medication administration charts were clearly printed by the supplying pharmacist. Any handwritten additions made by staff had been signed and countersigned, and there was photographic identification of each resident with their chart. Regular audits of medications had been commenced, however these needed to be more robust, as certain issues arose as a consequence of this inspection. In one case there was prescribed use of two different types of Paracetamol based tablets; we asked that this be reviewed with the prescribing GP, which the manager told us he had already identified to do. We saw protocols written to address the use of medications prescribed for use ‘as needed’, and this included the use of topical creams and lotions. However there was no administration record of topical preparations, and the manager was introducing individual administration charts into residents’ rooms to whom this applied, so that staff could sign for applying the cream at the time that they did it. We carried out two specific audits on some boxed tablets, and in each case we identified a discrepancy, with the number of tablets remaining being less than they should have been, taking account of the date of opening and the number of dosages signed for as having been administered. This could not be explained by staff at the time, but we agreed that the manager would investigate this and report back to us following this visit. Boxed and bottled items were generally dated on opening to assist with expiry times and auditing, however we identified one gap with this, meaning that auditing in that case was not possible. We checked the storage and recording arrangements for the controlled drugs in stock, and these were correct. More medication training was urgently required for staff, as there were a reduced number of carers sufficiently skilled to carry out medication administrations due to changes within the team. This was being sourced, and the manager was carrying out competency checks on existing staff in this area. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 15 Residents were generally very positive about their care. One person said they had received ‘prompt medical care’, and care records showed that external healthcare services had been sourced where needed, and that the home sought to work in a multidisciplinary way for the benefit of the residents. However, one person told us that there had been an occasion under the previous manager when medical help was sought by their own family after an issue they had raised was not taken seriously by her. This person went on to express greater confidence under the new manager. One resident said she ‘loved it here and had no regrets about coming in’. Another said Chargrove Lawn was ‘generally a very good home with good staff’. One resident said the home was ‘marvellous’, and that ‘the staff and attention were excellent’. Another said ‘I am generally well looked after. Some carers are better than others and more helpful. Sometimes I need more help than they are prepared to give; they say they are too busy. I think some of the staff need more guidance’. We observed respectful interactions between staff and residents, and personal care was being delivered in the privacy of residents’ own bedrooms. One particular resident told us that ‘staff always knock my door, and some of the staff are particularly person orientated’. A member of staff who responded to our survey told us that ‘Some staff shout at those who have hearing difficulty, some are rude, and this breaches residents’ dignity’. A resident told us that ‘Staff were respectful, although a couple of them were a bit loud around the residents’. A General Practitioner who responded to our survey was very positive about the home and raised no concerns at all. They told us the home was ‘Highly consistent in its care of residents; staff know the residents well, and use the GP services appropriately’. Residents’ wishes regarding any ‘end of life’ care featured on their assessment form, but these were not always completed. They were recorded in some cases. There were no specific plans of care regarding individuals’ advanced wishes in this eventuality, but the home was considering ways to implement a care planning system to address this as soon as possible. Chargrove Lawn DS0000016401.V375543.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some limitations currently imposed on the people living in this home in relation to organised social activity and the choice and quality of food, and there is some risk to their health and safety arising from certain practices in the kitchen. EVIDENCE: The home does not employ a designated social activity coordinator, with the minimum numbers of staff having to take responsibility for planning and arranging social events and activity for the residents. A monthly social diary was drawn up and issued to each resident and also displayed. This showed a variety of activities, including all sorts of games, musical movement, a trolley shop, a film show, and bingo. There was some mention in residents’ care plans about their needs in terms of activity, with a brief idea of preferences recorded, and whether encouragement would be necessary. However these were minimal and could be built upon to cater to needs in this area rather better. The new manager stated that he was fully Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 17 aware that he needed to continue to develop the social activity programme for residents, both in terms of content and delivery. One resident told us ‘there are social events, and the things on the monthly diary usually, but not always, take place’. One of the surveys returned to us stated that the home ‘Could do with providing more mentally stimulating activities’. Another wrote ‘We get excellent treats with a sense of festival at special times of the year’. One resident told us that they liked to ‘join in the music and movement for the exercise, but not much else’. They said they ‘liked to read, watch television or listen to the radio in their room’. This person also confirmed to us that he ‘experienced no prejudice in the home regarding his particular way of life’. Another resident said that she had ‘made some friends in the home, and went outside for walk’. She said her choices ‘were respected’. The AQAA stated that the home offered ‘open visiting’, and that visitors were encouraged to participate in home life. We spoke to one visitor who told us that they were ‘Very happy with the home, the care and the staff’. They also said that they ‘Feel very welcome here and able to be very involved in the care of their loved one’. The AQAA told us that residents were encouraged to be independent with their affairs as much as possible and could have personal effects in their rooms. We saw direct evidence of this being the case during the course of our visit. We saw useful information regarding advisory services and support agencies available in the home. A resident told us that he and his wife were free to choose what they did. He said ‘I often go out to the library and go shopping with family’, and said that he did a bit of letter writing and reading. A resident told us that she had wanted to remain in bed for a rest that day, and that she was ‘doing just that’. This person had chosen to have only soup for her lunch, and this was served to her in her room. We observed the overall service of the lunch time meal. The choices on the menu included gammon, however we were not entirely clear why this was not ultimately served, with the cook heard to say there were ‘no steak knives’. A meat rissole from the deep-freezer was served to most people, or a lamb burger, with croquet potatoes, also from the deepfreezer. There were some fresh vegetables however. A number of the residents were unable to eat the rissoles and burgers, saying they were difficult to cut. An attempt to cut them ourselves showed that they were tough, and very unappetising. There was a lot of food returned uneaten to the kitchen. The Group Care Manager told us that this should not be the case, and that frozen things such as this were usually only offered as extras if anyone wanted them, and should not have formed the basis of a main meal. The new cook Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 18 told us that he was ‘trying to reduce the amount of processed foods that had previously been purchased for the home’. There was a choice of at least three puddings. The supper menu included soup, a hot snack meal choice, and sandwiches and sweets. The tables were nicely laid, with condiments, napkins and drinks. The cook had attended a training course on ‘Cooking for The Elderly’, but their Food Hygiene training had long expired. We said that this must be addressed urgently, and the Group Care Manager told us that a training place was already booked for him. The cook told us that he ‘often spoke to the residents about the food’. One of the residents told us that ‘The cook is very obliging and talks things over with us’. We only briefly looked around the kitchen as this had recently been inspected by the Environmental Health Inspector, at which time a number of issues had been identified for the home to address. We saw clean and orderly food stores. However the kitchen was very untidy and the stove was dirty, although this was soon after food service. We saw the cook pull out a drawer underneath the cooker, and this was very dirty and completely littered with food debris. There was no catering assistant and care staff were walking in and out of the kitchen freely with no restrictions imposed upon them in order to assist the cook; this had clearly become the norm for the home, and was posing a health and safety risk. This has been raised with this home on a previous occasion. A member of staff who responded to our survey raised some concern about hygiene standards in the kitchen as well, saying that carers wander in and out getting themselves drinks. A staff survey returned to us said that the home ‘should provide better nutrition and a wider range of menus for lunch and supper’. In the main the residents were quite positive regarding the food. One person said ‘we get good food and choice, and can have a cooked breakfast if we want it’. One person said that the food ‘could be bit variable’. Chargrove Lawn DS0000016401.V375543.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have renewed confidence in the staff to help resolve their concerns, and although an isolated issue arose about unacceptable practice, the way in which the home dealt with it can reassure residents about the policies to protect their rights and prevent abuse. EVIDENCE: The home’s procedure for dealing with complaints and concerns was displayed on a notice board, and was issued to each resident within their information brochure; this needed updating as it still contained the contact details of the previous regulator, no longer in existence. Two residents told us that they had ‘no concerns to raise’, but had ‘complete confidence in the manager to help if necessary’. One resident said this would not have been the same under the previous manager, but that the new one was much better. There was a system for logging and dealing with complaints and concerns, and this showed the complaint regarding an unsatisfactory standard of cleanliness had been addressed. The home had ‘matters of concern’ forms, and we saw Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 20 evidence that one in relation to telephone access in a resident’s room had also been addressed. The home had policies and procedures for protecting the rights of the vulnerable residents, and staff confirmed that they had received training in abuse recognition and whistleblowing procedures. This had been delivered by a trained trainer within the CTCH Ltd organisation. One resident told us about ‘a bad attitude’ from one particular carer, saying that it was ‘verging on abusive’, although they felt that this would not continue under the new manager. Coincidentally the home had just disciplined this carer, against whom allegations of abusive conduct had been made. As a consequence, the person had been dismissed for gross misconduct and a referral to the POVA list (Protection of Vulnerable Adults) was possible after an appeal had been heard. There were records of statements, the disciplinary hearing and all associated correspondence on file. The home had informed us about this at the time it was ongoing, but had delayed in informing the Safeguarding Adults Team within the local authority. We discussed the importance of informing the team at the earliest stage in cases such as this. The police had not been informed, as this was not wanted by the resident concerned. A DVD training package had been sourced for The Mental Capacity Act 2005 (MCA), and the home had a copy of the MCA Code of Practice; training was set to commence for all staff. ‘Advanced Wishes’ care plans had not been devised with residents, but this was currently being planned to commence. Chargrove Lawn DS0000016401.V375543.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in this home cannot rely on a hygienically maintained environment on a consistent basis. EVIDENCE: A designated maintenance person was employed, although this was of a peripatetic nature within the organisation as a whole. Maintenance records were maintained. One of the residents who returned a survey form to us said ‘The award winning grounds are a pleasure throughout the year’, whilst another said ‘My hand towel holder broke and this took many weeks before it got repaired’. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 22 Since the last inspection raised flower beds have been constructed and a clock golf course. Some new garden furniture and dining room furniture has been supplied, and new lighting fitted in the communal rooms. Some of the arm chairs in the lounge were very worn and dirty, with at least two having ingrained food debris in the fabric of the arms. The pink carpet on the first floor corridor was worn, faded and stained. There was a faint and unpleasant odour upstairs. The double glazed sealed window unit in one of the bedrooms was damaged, with moisture trapped in between the glazing, partially obscuring vision through it. The plaster wall coverings in the corridors were chipped and unsightly. The previous manager told us in the AQAA that requests for decorative upgrading had been refused by the provider, although this was denied by the Group Care Manager when mentioned during the course of this inspection. One resident told us ‘It was a clean and comfortable home and had a nice atmosphere’. Another resident who responded to our survey told us that ‘Public rooms always seem to be clean and fairly well maintained, but bedroom cleaning leaves a lot to be desired. Food crumbs are left for days, also talcum powder is left on my bathroom floor’. A member of staff who responded to our survey raised some concern about cleanliness as well, saying that ‘The home needed two cleaners instead of just one because of the difficulty of one having to keep the whole house clean on her own’. This person said that ‘Some of the rooms were left without proper cleaning for weeks at a time’. Because of concerns about the standard of cleanliness in the home, extra staff had been brought in on a previous occasion for one week in order to deepclean the environment. We spoke to the housekeeper, who agreed that to keep the house clean on her own was ‘just too much’ for her, and that she ‘didn’t clean all areas every day’. We were told that the home was in the process of recruiting a second housekeeper so that seven day cover could be provided. However, this still only amounted to one housekeeper each day despite the increase in cleaning hours that would be achieved. We strongly recommend that this home have two housekeepers each day. The laundry room provides facilities to sluice and disinfect foul items. The room was very untidy when we saw it in the morning, with items strewn around the room and mop heads left on the floor. There were hand washing facilities with liquid soaps and paper towels. The home does not have a contract with a licensed collector of clinical waste. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are supported to develop the skills they need for their role, however shortfalls in their provision are posing a degree of risk to the health and safety of the people living in this home. EVIDENCE: The home’s AQAA declared minimal agency usage, and yet the dataset section showed that sixty-three senior carer night shifts had been covered by agency in the past three months. When we discussed this with the home management we were told that a good consistency of carer had been achieved, with those used being familiar with the home and its residents. The home appeared busy, and the staff on duty seemed very reliant on the new manager. They persistently approached him to talk, with seemingly little regard for what he was otherwise engaged in at the time. The manager told us that he had quickly recognised that many of the staff needed a lot of support and supervision. The manager worked in a supernumerary capacity, and the obvious need for a deputy manager was under consideration, as the previous one had been promoted within the organisation. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 24 We saw the staff rota, and this showed that three carers were on duty all day, with one waking carer and one sleep-in carer overnight. We expressed our concern over the sleep-in arrangement in particular, given the needs within the home, and some of the staff have indicated that this can pose problems for the waking carer. We have strongly recommended that there are two waking night carers in this home, and will continue to monitor the provider’s actions in response to us requiring that a review of staffing be undertaken. One of the carers told us that three staff during the day was not enough. One of the three carers also had to be responsible for kitchen duties, serving residents’ breakfasts and suppers, which evidently took them away from the care of the residents for a time. One of the staff who responded to our survey wrote ‘There are never enough staff to meet clients’ needs, with only one waking person at night’, and another indicating a high level of need amongst residents with minimum staffing to cope. This person told us that the home also needed a catering assistant in the kitchen. One of the carers told us about ‘an improving team spirit now’. A resident who responded to our survey told us that ‘Carers are competent and versatile. Increasingly they are overworked and a little fraught at times, and there is a shortage of staff’. Another said ‘Staff are friendly and helpful, though often overstretched’. There was an expectation upon care staff to undertake the National Vocational Qualification (NVQ) training course at a minimum of level 2. Five staff currently employed had already achieved this, and there were a further two on a course. One carer told us that she was keen to start the NVQ training as soon as possible. Two staff files of recently recruited carers were inspected. In each instance, the prospective employee had completed an application form, providing details of their employment history. In one of the cases the declared dates of previous employment referred to the year and not the exact dates, and should have been more precise. Interview notes were recorded, although in one case these were extremely brief. They did not show whether the employment dates had been explored at interview or not. Two written references had been provided in each case, including one from the last employer. Proof of identity and medical statements had been obtained. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. The new manager had discovered that the staff training records were in disarray. He had begun addressing this by gathering previously issued staff training certificates and devising a new training matrix from scratch. Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 25 Records showed that all staff had been booked on a refresher course for first aid this year. We confirmed that staff places had been allocated with an external training provider to provide training in moving and handling and food hygiene. Safeguarding adults training was mandatory and had been delivered, and COSHH (Control of Substances Hazardous to Health) training had been updated at the end of last year. Safe handling of medications training was to be updated as soon as possible. Staff confirmed to us that they had received fire safety training, but the latest records for this could not be located. The AQAA confirmed that staff had received training in core values and diversity, and we were told that the organisation is making training in Equality and Diversity mandatory for all staff this year. New workers were assessed for the level of induction training that they needed using a skills scan assessment tool. Records showed that those with no previous experience received training with an external training provider in accordance with the Common Induction Standards (CIS) for care workers. The outcome of this was further assessed in order to identify any further knowledge gaps for which additional training might be required. We were told that for a worker with previous care experience, any gaps in training and knowledge identified on the skills scan assessment would also lead to further training. A member of staff told us that she had not received a formally recorded inhouse induction programme when she had started work here, although told us that she had worked in a supernumerary capacity for at least a week, and had received good support and verbal instruction from experienced staff. We spoke to another carer who had just recently started working here. She told us that she was ‘shadowing an experienced carer’. She confirmed she had been trained in fire safety and moving and handling. Her CIS induction training was booked for the following week. The manager was meeting with this carer on the day of this inspection in order to go through the in-house induction record. The carer said she was receiving ‘good support and instruction’, and that it was ‘a supportive team’. We checked a copy of a blank in-house induction list, and this included learning about the environment, personnel issues, fire safety, people’s rights and health and safety. Chargrove Lawn DS0000016401.V375543.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although at an early stage, the recent changes and improvements to the management of this home have meant that residents living here have greater confidence that their interests will be safeguarded more consistently. EVIDENCE: A new manager had recently been appointed here. He is an experienced care home manager, has been registered with the previous regulator (CSCI) in the past in relation to another large home he managed, and is knowledgeable in this field of work. An application to register him with CQC is required in due Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 27 course. He confirmed that his required CQC CRB process had already been commenced in readiness. At the time of this inspection he was concentrating on getting to know residents, staff and families. Staff and residents told us that he was ‘approachable, friendly and helpful’. One resident told us that he had ‘Complete confidence in the new manager’, and that he was a ‘lovely chap’. Another resident and their partner said the new manager was ‘Very good, and had confidence in him’. A visitor and a resident said that the new manager had ‘Made a big difference since coming to the home already’. The AQAA had been completed by the previous manager prior to her departure, and some of the information proved to be unreliable when considered as part of this inspection. The list of policies and procedures was incomplete, and also showed that policies had not been reviewed for a long time. The AQAA told us that the home intended to ‘develop the quality assessment processes’. However, a quality assurance survey had not been carried out so far this year, although the home’s intention was to introduce them as soon as possible to residents, visitors and external professionals and stake-holders. A meeting had been planned for residents for the week following our visit. An invitation had also been extended to residents’ family and friends. A staff meeting had not been held, although the manager was consulting with staff about the home. The Group Care Manager had carried out a full audit in the home some weeks ago following some complaints being raised. A number of weaknesses had been identified, including the management of the home that was in place at that time, and has since been replaced; the lack of structured supervision for staff; and a poor standard of documentation. Individual care plans for residents regarding their decision making processes, and any restrictions or deprivations that may be applicable were being planned, although these had not yet been commenced. The manager was planning to do Deprivation of Liberty Safeguards (DoLS) training as soon as possible, as part of ensuring that the home will be compliant in this area for the benefit and rights of residents. Some residents had chosen to place personal money in the home’s main safe. Records were maintained, which contained evidence of running balances and transactions. We checked two arrangements, which we selected randomly. Clear records were being held in each case, with receipts attached to account for any financial transaction carried out by staff on the residents’ behalf. The new manager had recognised the need for stronger guidance and support for staff, and indicated that the team had lacked leadership to a degree. He said he needed to ‘build up trust’ within the team. He had issued each staff Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 28 member with an appraisal form regarding their personal development, training needs, the home generally, and any other improvements they would like to see, and was now awaiting the return of these. He attended shift handovers, and was working alongside the team, getting to know them. Records showed us that regular checks had been carried out on the fire safety systems, including the fire alarms, smoke detectors and emergency lights; these had been carried out by the maintenance person for CTCH Ltd. There was a record of fire drills carried out earlier this year. Fire safety training was reportedly given at the end of last year, but records to confirm this could not be located. Fire safety training had involved theory training using a compact disc package, with a knowledge test at the conclusion, and a certificate issued. Staff confirmed to us that they had received fire safety training. A fire safety evacuation plan had been formulated, but staff had not yet received practical training in this, but had received verbal instruction. Safety checks and maintenance of utilities and equipment had been undertaken. A stand-aid hoist on loan from community resources had recently been serviced by the supplier. Records indicated that the gas boilers had last been serviced over a year ago and would now be overdue. Hot water outlet temperatures were being checked for safe temperatures each month, although there was no record for the preceding two months; we saw evidence that any concerns about variations in temperature that were unsafe for residents were reported for action. First aid facilities were available, and staff were due to receive updated training in this area. Accident records were being maintained and any incidents were being regularly audited. We checked accident records in relation to some of the notifications that we had received regarding incidents affecting named residents, and we found that these corresponded. Chargrove Lawn DS0000016401.V375543.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 2 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 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 2 X 2 X 3 2 X 3 Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 Requirement The registered person must ensure that care plans are recorded to address wound management in cases where the Community Nursing service is providing support in this regard. This is to ensure that the care home staff can receive clear direction on the actions necessary to ensure consistency of care for the resident. 2 OP9 13 The registered person must ensure that there are adequately robust auditing arrangements in relation to the management of residents’ medications. This is to ensure that all medications are managed safely and accurately on residents’ behalf. 3 OP10 12 The registered person must ensure that staff behaviour and attitude remains respectful towards residents’ dignity at all times. DS0000016401.V375543.R01.S.doc Timescale for action 31/07/09 31/07/09 30/06/09 Chargrove Lawn Version 5.2 Page 31 4 OP15 16 The registered person must ensure that: • The kitchen is maintained in a clean and hygienic condition • Staff access to the food preparation area is restricted. This is to ensure that risks to residents’ health and safety in this area are reduced. 30/06/09 5 OP26 16 The registered person must ensure that the housekeeping arrangements are reviewed. This is to ensure that all areas of the care home can be maintained in a clean and hygienic state. 31/07/09 6 OP27 18 The registered person must ensure that a full review of the staffing levels in all areas of the home is undertaken, with necessary changes implemented. This is to ensure that the needs of the residents can be met in a safe and timely way at all times. 31/08/09 7 OP31 8 The registered person must 31/08/09 ensure that an application for the manager of the home is submitted to CQC for consideration. This is to ensure that a suitable manager for the service can be considered for registration by CQC. Chargrove Lawn DS0000016401.V375543.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 Refer to Standard OP1 Good Practice Recommendations A copy of the homes information brochure should be provided at the enquiry stage in order that prospective residents can have access to information about the homes services and facilities on which to make an informed decision. Staff should record individual residents’ wishes regarding the arrangements to manage their medications when they come into the home. The manager should review the social activity programme for residents, in order to ensure its content and delivery is appropriate for their needs. The manager should review the cook’s catering arrangements in order to ensure that residents’ meals are served in accordance with the planned menus. The proprietor should prioritise: • Replacing the heavily worn and dirty first floor corridor carpet • Repairing or replacing the damaged sealed glazed unit in the identified resident’s bedroom window • Repairing and redecorating the damaged and unsightly wall coverings around the home. There should be two housekeepers on duty in the week in order to manage the cleaning duties more effectively in all areas of the home. We are strongly recommending that there be two waking night carers on duty every night; And that a catering assistant be provided in the kitchen to assist the cook. The registered person should ensure that: • Documented policies and procedures for the home are reviewed as soon as possible • All information contained within the home’s AQAA for CQC is completely accurate. The manager should ensure that formal supervision is delivered to staff on at least six occasions in a twelve month period. 2 3 4 5 OP9 OP12 OP15 OP19 6 7 OP26 OP27 8 OP33 9 OP36 Chargrove Lawn DS0000016401.V375543.R01.S.doc Version 5.2 Page 33 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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