Inspection on 09/06/08 for Chargrove Lawn

This inspection was carried out on 9th June 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chargrove Lawn 04/06/09

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Chargrove Lawn Shurdington Road Cheltenham Glos GL51 5XA Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 9th June 2008 08:30 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.V360024.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.V360024.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 TBA Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th August 2007 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 £368.60 at the basic Local Authority rate of funding, up to £528.00 per week. Hairdressing, Chiropody, Opticians, Newspapers, Toiletries and Transport are charged at individual extra costs. Chargrove Lawn DS0000016401.V360024.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 1 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 inspector carried out this inspection over one day in June 2008. A check was made against the 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. Survey forms were issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. A small number of responses were received from residents and relatives, and some of their comments feature in this report. Some residents and one visitor were spoken to directly in order to hear their views and experiences of the services and care provided at Chargrove Lawn, and some of the staff were also interviewed during the course of this inspection. 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 safeguarding the rights of vulnerable residents were inspected. The arrangements for the recruitment, training, supervision 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. We required an Annual Quality Assurance Assessment (AQAA) from the home, which was provided, the contents of which informed part of this inspection. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 6 What the service does well: Chargrove Lawn offered pleasant surroundings and a welcoming atmosphere for visitors. We found that each prospective resident was assessed prior to being admitted here in order to ensure their needs can be identified and that the home will be able to meet them. We found evidence of good multidisciplinary working with outside health care services in order to meet the needs of the residents, with regular medical reviews and interventions going on. We found that residents themselves were very satisfied with the care they were receiving, saying things like ‘we get good care and attention here’. They also confirmed that they were afforded good levels of privacy and were able to make choices in their everyday lives. We found that, where possible, residents were able to retain their independence with their medications. Residents’ relatives and friends were welcomed into the life of the home, and there was a programme of social activities in which residents could choose to participate or not, and this had been devised in consultation with them. We saw a good quality meal being served, and residents were very complimentary about the standard and choice of meals available. There was a new cook in the home, who was very aware of the dietary needs of the residents and about nutrition for older people. We found that residents were reassured by the home’s policy for dealing with complaints and issues of concern, and they told us that they had faith and trust in the home, and that they ‘felt safe here’. Residents spoke well of the care staff, saying they were ‘kind and caring’. There was generally a thorough screening programme for new workers, with the required pre-employment checks undertaken, and appropriate supervision arrangements in place. We found that staff were generally being supported to develop professionally, and the National Vocational Training (NVQ) programme was available for care workers, with some already qualified and others on a course. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: There were some recording omissions in residents’ care plans, which potentially pose risks to residents in terms of care needs becoming overlooked or unmet. A statutory requirement issued for this shortfall at the last inspection had not been met in full, and has been repeated on this occasion. At the time of this visit the home was not fully complying with the recently revised regulations for the storage arrangements for a particular type of drug, but was taking steps to address this. Although the home was generally adequately maintained, there were a small number of maintenance issues requiring attention. The hygiene standards, although better on this occasion in some ways, were still poor in others. A statutory requirement issued for this shortfall at the last inspection had not been met in full, and has been repeated on this occasion. The home had been making efforts to recruit a new cleaner and care staff had been trying to do the cleaning temporarily. Although the care staff were attentive and caring when they were with residents, they were clearly very busy, and we found that they were deployed in very minimal numbers, and were also involved in non-care tasks as well. Due to some long-term staff absence there had been regular use of agency staff on some shifts, and one resident made the comment that ‘agency staff just don’t know us as well as the regular staff’. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 8 Health and safety of residents and staff was generally observed, but some improvement to the level of fire safety training was needed. The manager has not applied for registration with CSCI as is required, and this must now be addressed. 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.V360024.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.V360024.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. A satisfactory assessment process prior to admission to the home gives prospective residents an assurance that their needs can be met. EVIDENCE: We inspected two examples of pre-admission assessments, both of which were for residents recently admitted to the home. The first example was superficially completed, and did not include the date, a signature of the assessor or the location where the assessment was carried out. A copy of the Local Authority assessment and care plan had been obtained, and the assessor had liaised with the hospital ward and social worker in order to gain as much information as possible however. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 11 The second example was the most recent one. This one had been carried out at the person’s home address, and was signed and dated by the assessor, and was fully detailed. The assessor had also done some supplementary recording to ensure a good level of information regarding the person’s care needs and condition for when they came into the home. A confirmation letter had been issued, and this demonstrated a trial period had been offered, and a home information brochure had also been given. The AQAA stated that all residents received the same level of care, regardless of their funding source. Chargrove Lawn does not provide intermediate care. Chargrove Lawn DS0000016401.V360024.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. People living in this home generally have their health and care needs met, although gaps in recorded care planning are posing risks in this regard. EVIDENCE: Each resident had their own personal plan of care that had been drafted on the basis of a detailed assessment of their needs. The home’s AQAA confirmed that care plans were drafted in consultation with the residents, and that they are ‘service user focussed and reflect individuality’. Three were selected as part of the case tracking exercise to be inspected in closer detail. In each case the plan of care was directly linked to the assessments, which included a range of risk assessments. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 13 There were assessments to address the risks of developing pressure sores, the risks of falls, nutrition and manual handling. In the first case the manual handling assessment was not reflective of the person’s needs, saying that the risk was low. However due to previous concerns regarding the manual handling practices of some staff, given the difficulties and challenges that were inherent in this case, this needed reviewing to be more accurate. Also the associated care plan to address this person’s mobility lacked clear detail to direct staff, given the person’s level of cooperation during mobility. The plan contained clear guidance regarding this person’s dietary requirements. In the second case the pressure sore risk assessment identified no risk, but this person actually had a pressure sore. The assessment was totally inaccurate and had not been reviewed properly. A statutory requirement was issued following the last inspection for this type of omission, and is repeated this time. This person was also nutritionally at risk and was losing weight. Although staff seemed to be aware of the need to monitor in this case, there was no recorded plan of care to reflect the care or treatment needed here. The community nurse was attending to carry out wound dressings to the foot, which had become infected. Although there was a record of the nurse’s visits, there was no recorded plan of care for staff to follow in this area. This person had had a number of falls, and had been referred to the physiotherapist and occupational therapist for assessment and support. In the third case the person was at risk of developing pressure sores, but support equipment had not been introduced and all areas of skin were intact; there was no recorded rationale to support this decision. The care plan was reflective of the resident’s choices and levels of independence and was detailed and personalised. There was a list of their particular food intolerances, about which staff were aware. A risk assessment was in place for them walking out from the home. There had been regular access to a wide range of health care services in order to meet each person’s health needs, with a good multi disciplinary approach adopted in each case. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 14 The Care Home Support Team had been visiting regularly, with some collaborative working to promote health benefits for the residents. All residents and visitors who responded to the survey were very positive about the standard of care they received. Those residents spoken to directly were also very satisfied with the care they had, with comments received such as ‘we get good care and attention’, and ‘the staff are caring and kind, although very busy’. One resident said they had been ‘very happy with the decisions taken’ in relation to their care, and had been ‘regularly consulted’. One visitor spoke of ‘the marvellous care’ their relative had received whilst in the home, and was very disappointed to know that, because of changes in their relative’s health needs that could no longer be met in this type of care home, they would be unable to stay here. Staff were witnessed as attentive when dealing with residents. Two residents were managing their own medications, and this was being done within a risk management framework. In one of these cases there was no medication record for the one item the resident was using, and the manager addressed this during the course of this visit to make sure a clear record was held as required. The home had introduced tighter controls in relation to the management of residents’ medications, with regular auditing carried out. Protocols were in place to address the directions for use of medications prescribed ‘as needed’, and care plans also contained information in relation to the use of external creams. Medications were securely stored. Further to recent amendments to statutory regulations for controlled drug storage in care homes offering personal care, the home is now required to provide compliant storage facilities for such medications. The manager and group care manager confirmed that this was being addressed, with a cupboard now on order. Medication administration charts were clearly printed, and were fully recorded by the staff. In one case a hole punch had obliterated one small part of the medication directions. A carer was observed administering the lunchtime medications, and this was done safely. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 15 Randomly selected audits were conducted on two medication stocks, and each of these was correct. Staff responsible for managing medications had been trained in Safe Handling of Medication, and the manager had carried out some competency checks. Residents confirmed that staff respected their privacy, and were respectful towards them. Each confirmed their satisfaction with the level of privacy they had within their rooms. Chargrove Lawn DS0000016401.V360024.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 the opportunity to remain reasonably active socially, exercise choice, and have a nutritious diet that offers choice and variety. EVIDENCE: Chargrove Lawn does not have a designated coordinator for social activities, with allocated staff taking responsibility in this area as needed. Records of activity were seen, but these had only been recorded sporadically. Residents had been consulted regarding their ideas and interests for social activity, and a calendar of events was in progress to suit a variety of tastes. The AQAA stated that the home has joined with a ten-week art programme for those residents wishing to participate with this, and had planned a number of outings for the summer months. Some of the residents said that they liked to join in socially, whilst others said that they preferred not to. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 17 One resident said they preferred to do their own crosswords, and read their own newspaper that was delivered for them. A small number of the residents attended social and religious events in the local community, and many of the residents were able to go out with their families. A religious service was held in the home each month, although two residents still went out to their own church. One particular resident received pastoral support from a different denomination to others, and another resident regularly went out to attend alternative therapy sessions. One resident who was registered with sight impairment had just been supplied with a talking book. A mobile library regularly visited the home, providing a selection of reading material for the residents. Two residents commented that the social activities offered ‘were good’, and that ‘trips out were organised’. However, it was noted that many residents were observed sitting in the lounges at various times during the day, with no staff in evidence, and with very little going on around them. One visitor wrote on a survey that ‘staff were friendly and encouraged residents to socialise’. Another wrote that the home ‘needed more activity’. The AQAA stated that the home aims to be welcoming for visitors. The residents confirmed that their visitors are made welcome here, and can visit when they like. One visitor said that ‘this was a wonderful home’, and that ‘staff were very supportive’ to them. Residents confirmed that they felt able to make choices in their lives, and that the staff showed respect towards this. Some were observed moving about the home as they wished, and pursuing their chosen activity as they wished. One resident said that ‘we can choose what we want to do’. The residents had been supported to personalise their own rooms, and many were very individual, containing personal effects. Copious information was available, and on display in the home regarding advocacy, support and information services that may be of use to some. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 18 Staff were witnessed being mindful of residents’ choices, and residents were offered choice with their meals and drinks. The dining room had been attractively laid for lunch, and the cook was seen preparing and serving the meal, and was serving on the basis of a list of residents’ choices that had been compiled earlier. There were at least two choices of main course and pudding, and the menus also demonstrated a good level of choice at suppertime. The meal looked plentiful, hot, fresh and very appetising. Residents confirmed their satisfaction with the quality of food offered to them, with all saying that ‘lunch had been really good’. One resident said ‘the food wasn’t posh but was tasty and offered good choice’. There was a relatively new cook on this occasion. She was very knowledgeable regarding the dietary requirements for the residents, and was evidently very caring and interested in providing a good meal service for them. She had received training in ‘Cooking for Older People’, which she said had trained her about special diets and providing nutritious options for people. Homemade cakes had been prepared for the afternoon tea, and snacks were available at other times of the day. Catering records were maintained, although there were numerous omissions in the afternoons, when care staff take responsibility for the suppertime meal. Food was stored appropriately. Chargrove Lawn DS0000016401.V360024.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 good. This judgement has been made using available evidence including a visit to this service. People living in this home can be reassured by the home’s complaints procedures and the policies regarding the prevention of abuse. EVIDENCE: A copy of the home’s complaints procedure was displayed, and had been issued to residents in their information brochure. The home’s AQAA stated that no complaints had been received in the past twelve months, although this was not accurate with one having been investigated in that time, which had been overseen by CSCI. Since the AQAA had been completed the complaint records showed that some potentially serious concerns had been raised in relation to a resident’s money. Records contained evidence of a very full investigation that had been carried out by the group care manager, with satisfactory resolutions and outcomes achieved for all concerned. The records also contained records of any small matter of concern that had been addressed. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 20 A number of residents said that, ‘although they didn’t really have any concerns or complaints’, they felt that the staff would respond well and ‘would do what they could to help them’. A visitor said that she had had cause to raise a concern and that the manager and the deputy manager had been approachable and helpful. The home had policies and procedures for safeguarding the vulnerable residents, which included whistleblowing procedures and local contacts should the need arise. Staff confirmed they had received training in the protection of vulnerable adults, and each of those spoken to was confidently conversant in this area. Each was able to discuss recognition and types of abuse, and was able to discuss the safeguarding protocols to follow should the need arise. The home had obtained information about the Mental Capacity Act, and the manager and deputy had received training in it. Other staff had not, although the home had a set of learning materials to address this as soon as possible. There had been one staff disciplinary action as a result of unacceptable practices in the home. Some of the residents said that they ‘trusted the staff’ and ‘had confidence in them’. Some confirmed that they ‘felt safe here’. Chargrove Lawn DS0000016401.V360024.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 adequate. This judgement has been made using available evidence including a visit to this service. People living here are provided with a reasonably maintained environment, but some poor hygiene standards are continuing to pose a degree of risk to the health and welfare of residents in certain areas. EVIDENCE: The AQAA stated that the home had received a monetary grant to improve the garden and patio area for the residents. This area was accessible and appeared very pleasant, and now had raised flowerbeds, and included seating for residents. The home had access to a maintenance person, and in the main the home was adequately maintained. The passenger lift had recently broken down due to a power failure, and this had been quickly rectified. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 22 The ceiling extractor fan in one of the en-suite bathrooms was clogged with dirt and bits and was not working. The ‘self-closing’ door to the smoking room did not close properly unless it was manually pushed, and if left would not contain any smoke and odours. One visitor wrote on a survey that the home needed a better television reception. There had not been a cleaner in post for some time, and care staff had had to assume responsibility in this area, with additional help brought in during the afternoon. This was not considered entirely appropriate, given the numbers of residents that care staff had to care for, and evidently the standards of cleanliness, although slightly better on this occasion, were still not adequate in certain areas. A statutory requirement was issued following the last inspection for this failure, and is repeated this time. Efforts were being made to recruit a new cleaner. Carpets were covered in bits and had not been vacuumed, and an en-suite toilet had been left in a dirty condition. An offensive odour was evident in at least two rooms, with one of these containing a very dirty shower trap. The laundry room was very cluttered and untidy. The washing machine was capable of laundering foul items in accordance with infection control protocols, and liquid soap, paper towels, gloves and aprons were provided. The community nurses had removed any wound dressing clinical waste, and the manager stated that sharps waste, although minimal, was taken to the group’s nursing home for disposal. The home had liaised with the local council regarding disposal of incontinence waste, and was continuing to double bag it and put it out for household collection, having not been advised to the contrary by the council. Chargrove Lawn DS0000016401.V360024.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. 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. Despite some slight concern about the minimal levels of staff deployed here, people living in this home receive care from a competent work force, who undergo full pre-employment checks, and who are supported to train and develop professionally. EVIDENCE: The staff rota allowed for three care staff to be on duty during all daytime hours, with the manager or deputy manager supernumerary during the weekday mornings, and on an occasional evening as well. There was one waking and one sleep-in carer overnight. These numbers were considered to be very low, and the barest minimum for the twenty-six residents. Following the last inspection the home was required to carry out a review of staffing levels, and this was done. The group care manager and proprietor were satisfied at that time that the numbers of staff were able to meet the needs of the home. It is acknowledged that this exercise is due for a repeat, and the care hours calculator tool that will be used was seen. It is anticipated that this latest Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 24 exercise may then demonstrate that staffing should be increased, at least at certain times. There is little ancillary support in the home, with care staff carrying out catering duties at breakfast and suppertime, cleaning and laundry. This noncare time for at least one of the carers inevitably detracts from the staff available to residents at times. However, the cleaning is temporary and some effort had been made to provide some extra hours to accommodate this within the care team. Two staff were on long term leave from the home, and a significant amount of agency staff were being employed. The manager said that they had managed to secure a degree of consistency with those used. None of the staff returned survey forms to CSCI. Staff themselves said that they were always very busy and had a lot to deal with. This seemed to be particularly the case when coping with catering duties. This was echoed by the residents themselves, although they spoke well of the staff team, with comments received such as ‘ they are kind and helpful’, and ‘they’re marvellous and give me all I need’. They also confirmed that they are rarely kept waiting for a response to their call bell during the night. One resident commented on the use of agency staff that had been happening recently, saying that ‘agency carers didn’t know them as well as the home’s own staff’. One visitor said that ‘the staff couldn’t do enough for people’. The home’s AQAA stated that eight care staff had achieved the NVQ (National Vocational Qualification) award at level 2, with another two undergoing training for the level 3 award. Two files of recently recruited staff members were inspected. In each instance, the prospective employee had completed an application form providing details of their employment history. Interview notes were recorded. Two written references had been provided in each case, with contact made with the previous employer. Proof of identity and medical statements had been obtained. In one case a copy of the photographic evidence had not been kept, and the manager was addressing this. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person, and CRB disclosures were seen directly. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 25 Offer letters of employment had not been issued at the time of this inspection. Each had had induction training, although this had just been in-house. The home assessed the needs and experience of the new worker before deciding on the level of induction needed, and in some cases the worker had attended more in depth induction with an external training provider, covering the Common Induction Standards for care workers. Each had worked under supervision during this period, although a record of the supervisor was not evident in writing when checked. The training matrix was out of date and the manager acknowledged this was an area of priority now. A standard training matrix was to be introduced here, so that all homes within this care group use a standard format. Training in dementia care had recently been delivered, and some had received a manual handling training update, although more were due. Infection control training had been delivered to three care staff, and each had received training in adult protection, with those responsible for managing residents’ medications being trained in safe handling of medications. Further training was planned in care planning and record keeping. It was acknowledged that training in food hygiene needed updating. Chargrove Lawn DS0000016401.V360024.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, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management systems that have been in place here have largely ensured that the interests, and health and safety of the residents have been adequately safeguarded, however more focus is needed towards certain aspects of health and safety awareness for staff. EVIDENCE: The manager has now been in post for nearly six months, and so far had not submitted an application to register with CSCI. She is required to address this now. She is a first level nurse, who has achieved the Registered Manager’s Award. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 27 The group care manager and the proprietor have stated, separately to this inspection, that during these initial months of her management they have been closely monitoring the home’s performance. The manager said that since coming into the home she had embraced the challenges and the staff relationships that she had here. A visitor said that the manager and the deputy manager were ‘fantastic’. Two staff said the new manager had been ‘supportive, accessible and was approachable’. The Provider had ensured that very regular monitoring visits had been carried out to this home as part of their quality monitoring systems, and that the necessary support had been available for the new manager. The group care manager said she had been monitoring the home’s progress to effect the improvement plan provided by CSCI. Survey questionnaires had recently been sent out to residents, their families, and visiting healthcare professionals to complete, as part of a quality monitoring approach. The survey questions had been devised in line with the National Minimum Standards and covered equality and diversity. The results of the surveys were being collated and the manager confirmed she would draw up an action plan to address any issues that arose. A meeting had been held for residents, although a record of the minutes was unavailable for inspection. A suggestion box was placed in the entrance hall. The AQAA indicated that most policy documents had not been reviewed for some time, and acknowledged that quality monitoring was an area the manager wished to improve upon. The home offered a safe system for looking after residents’ money and valuables if they wished, and a number had chosen to use this. All items were held securely, and well-kept and transparent records were held in each case, providing a clear audit trail throughout. Staff confirmed they had each received a personal supervision session with the manager. The manager said that there were two due to be done by the deputy manager this week. She said that sessions had covered a ‘general getting to know each other’, and training needs. Staff said they had found the sessions useful. The home has worked hard towards developing a more robust fire safety risk assessment, with evacuation plans drawn up for resident safety. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 28 There had been no staff training in this area yet, apart from discussion with individuals, but practical evacuation training was planned. There was a record of two fire drills for the month of April, but this had not encompassed the night staff. The home had a variety of learning materials for staff to receive fire safety training, although these had not been employed for anyone recently, and had yet to be applied to the new workers who had only received basic instruction to date. Regular checks had been carried out on the fire alarms, smoke detectors, fire extinguishers and emergency lighting. Safety checks had been carried out on the heating, the hot water temperatures and the electrical equipment to ensure safety, and records demonstrated that the passenger lift and other miscellaneous equipment had also been serviced. Records for the most recent heating boiler service were not available for inspection, but the manager said this had been carried out in March of this year. The hoists in the home were being provided through the community loan scheme, and servicing arrangements were made by the scheme themselves. Six staff had received basic training in first aid, and first aid facilities were provided and regularly checked. Chargrove Lawn DS0000016401.V360024.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 3 2 X X X X X X 2 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 3 X 3 3 X 2 Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 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. This requirement has been repeated from the last inspection. 2. OP8 12(1b)13( 4c) The manager must ensure that 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. This requirement has been repeated from the last inspection. 3. OP19 23(2b) The registered person must ensure that the home is maintained, specifically on this occasion that: • The extractor fan in the DS0000016401.V360024.R01.S.doc Timescale for action 31/07/08 31/07/08 31/08/08 Chargrove Lawn Version 5.2 Page 31 • identified en-suite bathroom is repaired to full working order The self-closing door to the smoking room is repaired so as to close in fully when shut. 4. OP26 16(j.k) Residents’ rooms and en-suite 31/07/08 bathrooms must be thoroughly cleaned and then maintained in a hygienic and odour free state. This requirement has been repeated from the last inspection. 5. OP31 6. OP38 Care Standards Act 2000 Section 11(1) 23(4d) An application to register the manager of the home with CSCI must be submitted for consideration. The manager must ensure that all staff, including night staff, receive fire safety training in order to ensure their ability to protect the residents in the event of a fire. 31/08/08 31/07/08 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 OP7 Good Practice Recommendations Staff should record their rationale in the care plan for not introducing support equipment in cases where a pressure sore vulnerability has been identified. Mental Capacity Act training should be provided for all staff. DS0000016401.V360024.R01.S.doc Version 5.2 Page 32 2. OP18 Chargrove Lawn 3. OP27 There should be an increase in the amount of ancillary workers to reduce the added non-care duties placed upon care workers. A catering assistant should be provided in the evenings. Chargrove Lawn DS0000016401.V360024.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V360024.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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