CARE HOMES FOR OLDER PEOPLE
Charnwood House 2 The Avenue Fairfield Stockton-on-Tees TS19 7EY Lead Inspector
Neil McKenzie Key Unannounced Inspection 31st May 2006 11:30 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 Charnwood House DS0000000004.V298276.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. Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Charnwood House Address 2 The Avenue Fairfield Stockton-on-Tees TS19 7EY 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) 01642 884001 Mrs Mary Elizabeth Serwan Mr Rajman Serwan Mrs Mary Elizabeth Serwan Care Home 16 Category(ies) of Dementia - over 65 years of age (16) registration, with number of places Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Three named individuals who are under the age category are allowed to reside in the home. 29th November 2005 Date of last inspection Brief Description of the Service: Charnwood is a care home providing personal care for older people with mental health needs. It is a large Victorian/Edwardian detached house providing both single and shared accommodation for 16 Residents. There are 12 single bedrooms and 2 double bedrooms. The single bedrooms are a minimum of 10 sq.m and the double bedrooms are a minimum of 16 sq.m. There is a passenger lift giving access to the upper floor. There are three lounges (one of which is for those Residents who smoke) and a large communal dining room. The current scale of charges is £343.00 per week. Additional charges include Chiropody, hairdressing, dry cleaning and personal items. There is a small car park at the front of the home. Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection, which was unannounced, started at 11.30am and finished at 6.30pm. The inspector discussed how people live their lives at Charnwood with the manager, the owner, 2 residents, 1 relative and 2 staff. The inspector observed and noted how staff and residents interacted with each other. A tour of the home was undertaken. Documents and records looked at included resident files, staff files, and the handling of resident money and medication. As well as the unannounced visit additional data was collected via the preinspection questionnaire, relative survey and a telephone call to a General Practitioner who has provided a service to residents living at the home for 10 years. None of the resident surveys’ provided by CSCI were returned. What the service does well:
The manager and staff at the home are good at providing a friendly and homely atmosphere. One visitor who spoke to the inspector commented that ‘we wanted somewhere homely and we are very satisfied’. Residents benefit from a staff team who have worked at the home for many years and have a good knowledge of the residents they care for. This good knowledge is also based on some residents having had other family members live at the home. As a local General Practitioner stated, ‘staffing wise they know the residents, are very supportive and know what is going on when there is a problem’. Another resident stated that she liked living at the home because it is close to her family, ‘really close to family and friends and they look after me well and see that I am alright’. There is a training programme in place and 60 of the staff have their National Vocational Qualification (NVQ) Level 2 and 3 in Care with other staff started the course. This includes a staff member completing a NVQ Level 4 in Care. Training files demonstrate additional training that are mandatory, for example, manual handling and the safe handling of medication, and resident specific training such as dementia awareness, case recording and bereavement. As one staff member stated, ‘ really good at learning here’ Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 6 The home is waiting re-confirmation as an Investor In People. This award is in recognition of training and support provided to staff by the home to help them deliver a quality service to residents. The home is good at providing personal support with regard to specific cultural interest of residents with the use of interpreters, and family networks. What has improved since the last inspection? What they could do better:
Safety and comfort needs to be improved by making good loose boards on the top floor landing and the replacement of broken wardrobes and furniture in resident rooms. In general the home is in need of an overall refurbishment to bedrooms and communal areas. This must include a maintenance schedule that identifies key areas of work and time scales for the replacement of main hall stairway and bedroom carpets and the decoration of recently plastered walls. At the time of the inspection the daily menu offering a choice of meals was not displayed. Cups and mugs provided to residents were badly stained and in need of replacement. The home must review appropriate staffing levels, with particular regard to no senior staff working at the home at weekend and the risk management of staff cover of leave/sickness. This is to ensure all residents’ needs are met at all times and to promote the safety and wellbeing of residents. As on staff member stated, ‘sometimes I am running about doing 2 jobs at once’. The home must obtain the required information and documentation during recruitment and appointment of staff and ensure this information is kept in staff files at the home.
Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 7 Residents would be better protected if staff received up to date training on the Protection of Vulnerable Adults. Speaking to residents there was a suggestion that there could be more organised activity. The manager confirmed that currently there are no organised trips out. One of the residents stated, ’I would like it if we could go out on trips more and visit the seaside’. 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. Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 8 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 Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 The quality in this outcome area is good. This judgement has been made using available evidence from resident files and interview with resident and relative. The contract specifying terms and conditions for two residents was not available at the time of the inspection. EVIDENCE: Admissions are not made to the home until a full needs assessment has been undertaken. Evidence from resident files sampled confirms that the assessment is conducted professionally and has involved the family and or representative of the resident. It was noted at the time of the inspection that two of the residents had been recommended to the home by family members who had positive experience from other relatives living at the home. As one relative stated, ‘we were looking for a family home for my sister and her mother had been here and we are now very satisfied that my sister is here’. Where residents are admitted from different cultural backgrounds specialist and additional information is documented in the original assessment to ensure that their specific needs are full met. For example, it was documented that one resident would require the assistance of an interpreter on a regular basis.
Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 10 In two of the three resident files the statement of terms and conditions that sets out the fee, the role and responsibility of provider, rights and obligations of resident were not available. Explanation provided by the manager is that they have just been reviewed and residents are waiting for them to be agreed and returned by their family. The home must ensure that these contracts once agreed are returned and located in resident files. Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The quality in this outcome area is good. This judgement has been made using available evidence from resident files, the pre-inspection questionnaire, relative survey and interview with resident, staff and General Practitioner. Each resident has a plan that considers their health, personal and social care needs. The home ensures that these plans are reviewed on a regular basis and where agreed involves the family. Residents’ are protected by the home’s policies and procedures for dealing with medication and by staff trained and qualified to administer the medication. Residents spoken to felt they were treated with respect and dignity. EVIDENCE: In the files sampled by the inspector each resident had a personal care plan that is reviewed on a regular basis and supported by daily records documented in their file. This care plan is promoted by the home as each resident is allocated a key worker and resident specific training is provided for the key worker that includes care planning. As one resident commented, ‘my head carer takes care of all my wants’.
Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 12 The care plans where agreed involve family members. One resident stated, ‘my daughter reads my care plan and has been doing so since I moved in’ Residents benefit from a staff team who have worked at the home for many years and have a good knowledge of the residents they care for. This good knowledge is also based on some residents having had other family members live at the home. As a local General Practitioner stated, ‘staffing wise they know the residents, are very supportive and know what is going on when there is a problem’. The home is currently changing from the Boots Medication Dispensing System (MDS) to the Rowland’s MDS. This is due to happen at the end of June and the manager said this is to be accompanied by an in house induction to the system to the staff trained and qualified to administer medication. Currently residents are protected by the home’s policies and procedure for dealing with medication and these were reviewed by the home in February 2006. Staff training records confirmed that they receive training on how to administer and handle medication. A sample of MDS records presented as accurate and up to date. The residents’ who spoke to the inspector stated that staff treated them with respect and dignity: ‘I get help when I need it and it is done the way I like it, for example, I don’t like to go up in the lift on my own’. ‘I like it here, I am not afraid to ask for help and they are always polite’ ‘This place is a sanctuary’ A relative in her survey stated, ‘the care my mother has received off most of the carers has been excellent. They treat her as if she is their own mother with respect’. Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality in this outcome area is adequate. This judgement has been made using evidence from a tour of the home, observation, resident care plans and interview with resident, staff and relative. Family members are made to feel welcome when visiting the home. Residents and family are consulted about opportunity to take part in activities inside and outside of the home that also reflect cultural preferences. Some residents felt there could be more done in this area. Residents are satisfied with their diet but at the time of the inspection there was no menu displayed and the dining room required further decoration. EVIDENCE: The home does not provide a structured activity/recreational programme for residents. At the time of the inspection it was observed that people were involved on a variety of activity encouraged by staff, such as singing to songs. A resident who benefited from going out once every two weeks felt that more could be done and stated, ‘ I would like it if we could go out on trips more and visit the seaside’. The manager confirmed that currently there are no organised trips out, ‘find it a struggle’ Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 14 Resident care plans referred to individual and cultural interest/preference, for example, going to the pub/library and a visiting Priest, and the manager spoke about promoting this more with residents by the use of volunteers. The inspector observed how family members when visiting the home were made to feel welcome. As one resident stated, ‘my family look after me really well and see that I am alright, my niece buys me cream cakes and brings them to me’ All the resident surveys returned were satisfied with how the home welcomes and consults with them. A General Practitioner commented, ‘when visiting residents and family the staff take you off to the lounge to ensure privacy’ At the time of the inspection the home had not displayed a daily menu offering a choice of food and the dining area, whilst benefited from new carpet, required new wallpaper to replace the existing damaged wallpaper. Cups and mugs provided to residents were badly stained and in need of replacement. However, residents spoken to were satisfied with the amount and quality of food. One resident commented, ‘ Food is always cooked and prepared for you well here, my favourite is Shepherds pie’. Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality in this outcome area is good. This judgement has been made using evidence from the pre-inspection questionnaire and interview with resident, staff and the relative survey. Residents are protected by a complaints procedure that is available in the home and policy and procedures on Adult protection and prevention of abuse that are up to date. EVIDENCE: A complaints procedure was displayed in the home and as one resident said, ‘If I had a problem I know what to do’. Relatives in their survey were able to say they would know what to do if they had a concern and or complaint. There have been no complaints during the last 12 months. The residents are protected by an Adult protection and prevention of abuse policy that was updated in February 2006. One resident commented how safe he felt in the home and described the home as ‘place that gives you sanctuary’. Staff are aware of the policies and procedures but would be better equipped to protect residents from abuse, neglect and self-harm if they received up to date training on the protection of vulnerable adults. There have been no recorded incidents of adult protection during the last twelve months. Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The quality in this outcome area is adequate. This judgement has been made using evidence from a tour of the premises, the pre-inspection questionnaire and interview with staff. The residents on the whole live in a well maintained home although there is a need for a planned refurbishment and decoration of bedrooms and communal areas. The home presented as free from unpleasant odours. EVIDENCE: Safety and comfort needs to be improved by making good loose boards on the top floor landing and the replacement of broken wardrobes and furniture in resident rooms. In general the home is in need of an overall refurbishment to bedrooms and communal areas. This must include a maintenance schedule that identifies key areas of work and time scales. In particular with regard to the replacement of main hall stairway carpet, resident bedroom carpets that are badly stained and the painting of recently plastered walls, that includes the wallpaper in the dining room.
Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality in this outcome area is adequate. This judgement has been made using evidence from, the pre-inspection questionnaire, rota, staff files and interviews. Evidence indicates that on the whole residents’ needs are met by a compliment of trained staff. The home, however, must ensure that relatives employed by the home are subjected to two references before they are confirmed in post. The home has at any time 2 staff for 16 residents but has no senior staff working at the home at weekends and no extra cover at times of sickness/leave. EVIDENCE: There is a training programme in place and 60 of the staff have their National Vocational Qualification (NVQ) Level 2 and 3 in Care with other staff started the course. This includes a staff member completing a NVQ Level 4 in Care. Training files demonstrate additional training that are mandatory, for example, manual handling and the safe handling of medication, and resident specific training such as dementia awareness, case recording and bereavement. As one staff member stated, ‘ really good at learning here’ The home is waiting re-confirmation as an Investor In People. This award is in recognition of training and support provided to staff by the home to help them deliver a quality service to residents. Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 18 The sampling of staff files revealed that one staff member who is a relative of the owner of the home had not completed an application form and the home had not pursued two references. The home must ensure that they obtain the required information and documents specified in Care Home regulations. The home must also review appropriate staffing levels, with particular regard to senior staff cover at weekend, currently there is no senior staff on duty at the home at the weekend, and the risk management of staff leave/sickness. This is to ensure that all residents’ needs are met by the home having sufficient staff numbers. As one staff member stated, ‘sometimes I am running about doing 2 jobs at once’. Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The quality in this outcome area is good. This judgement has been made using evidence from, the pre-inspection questionnaire, interview with the manager and the sampling of resident finances. The home is run and managed by a person who is fit to be in charge. Residents are not formally consulted about their views of the home. Resident is safeguarded by policy and procedures that were up to date. EVIDENCE: The home is run and managed by a person who has the required nursing and management qualification and management qualifications to ensure that the needs of residents are fully met. Residents and staff spoke highly of the manager. Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 20 Although one could observe daily interaction between staff and residents about how they were finding things there is no formal consultation event with residents that publish their views on what life is like living in Charnwood. For example, regarding the homes provision of activities and choice of menus. The home is waiting re-confirmation as an Investor In People. This award is in recognition of training and support provided to staff by the home to help them deliver a quality service to residents. The sampling of resident monies found that the transaction of monies followed procedures and records were accurate. As a resident stated, ’I have a bank account and the carer draws the money out for me and puts it in a tin’. Details of health and safety were made available through the pre-inspection questionnaire and were presented as up to date. Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 21 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 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 3 X X 3 Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP24 Regulation 16© Requirement The home must provide refurbish and decoration schedule that addresses the stairway carpet, replacement of broken furniture and the decoration of recently plastered walls. The home must provide a daily menu that is displayed and demonstrates choice at meal times. The home must replace stained mugs. The home must review and complete a risk assessment to ensure that at all times there is a suitable number of skilled staff working at the care home. The home must consult with residents to ensure a programme of resident activities is arranged by the home The home must ensure staff are better equipped to protect residents by ensuring they receive training on the Protection of Vulnerable Adults. The home must ensure that all staff recruited to work in the
DS0000000004.V298276.R01.S.doc Timescale for action 30/06/06 2 OP15 16(i) 31/05/06 3 4 OP15 OP27 16(g) 18 (a) 31/05/06 30/06/06 5 OP12 16(n) 30/06/06 6 OP18 18© 30/09/06 7 OP29 19(4) 30/06/06 Charnwood House Version 5.2 Page 23 home has the required information and documents before appointed and these are kept in staff files at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Charnwood House DS0000000004.V298276.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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