Inspection on 10/09/08 for Charter House

This inspection was carried out on 10th September 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Charter House 12/09/07

Charter House 17/08/06

Charter House 17/05/06

Charter House 15/02/06

Charter House 21/10/05

Charter House 15/11/04

Charter House 06/04/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Charter House 15 Queens Road Donnington Telford Shropshire TF2 8DB Lead Inspector Deborah Sharman Unannounced Inspection 10th September 2008 09:15 Charter House DS0000020543.V371754.R02.S.doc Version 5.2 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 Charter House DS0000020543.V371754.R02.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 Adults 18-65. 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. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charter House Address 15 Queens Road Donnington Telford Shropshire TF2 8DB 01952 406690 F/P 01952 676865 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) Mrs Sukjit Kaur Kang Mrs Sukjit Kaur Kang Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2007 Brief Description of the Service: Charter House is a care home providing accommodation and personal care for up to eight people with difficulties with mental health. It is privately owned and is a detached property situated in a residential estate in Donnington, Telford. All bedrooms are single occupancy none of which have an en suite facility. The communal areas are homely and domestic in character. The property is undergoing a refurbishment and redecoration programme. The weekly fee is not stated in the Service User Guide. Therefore enquiries about the fee should be directed to Charter House. Charter House DS0000020543.V371754.R02.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. One Inspector carried out this unannounced key inspection between 9.15 am and 6.15 pm. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection as ‘key’. These are the National Standards, which significantly affect the experiences of care for people living at the home. Information about the performance of the home was sought and collated in a number of ways. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The acting manager completed this document and returned it the commission after the deadline given. Comments from the AQAA are included within this inspection report. In addition prior to inspection we sent surveys out to people who live at Charter House and to independent health professionals who provide their services to the home. We received completed surveys from two professionals and five people who live there. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. The Registered Manager was not available although the deputy manager and a senior staff member were available throughout the inspection to answer questions and support the inspection process. We were able to talk to staff including new staff and met and spoke to three people who live there, two in detail. This included a new resident. We assessed in detail the care provided to one person using care documentation and observation. We also toured the premises and sampled a Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 6 variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, accidents and complaints. All this information helped to determine a judgement about the quality of care the home provides. What the service does well: What has improved since the last inspection? What they could do better: Guidance available to staff to tell them how to support people is not always available in respect of people’s key needs. A resident raised a concern with us at inspection, which have since been forwarded to the local community mental health team for investigation. The outcome has confirmed how better guidance for staff may have avoided the concern arising. Medication is managed satisfactorily, with residents receiving their medication. However some medication systems could improve to ensure this can always be accounted for. Staff must also check with a medic before administering over the counter remedies. Staff are not medically qualified and cannot be sure such remedies will not react with current prescriptions. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 7 This inspection found service users’ monies to be much better managed, assuring service users improved protection. However we found processes used to recruit new staff to have deteriorated significantly. Staff supporting the inspection agreed that this has placed people living at the home at risk. The need to improve the environment is ongoing and small improvements are made at each inspection although they never seem to be sufficient to improve the overall feel of the premises. However people living there are comfortable and never raise this as a concern. What is a concern however is lack of the management of the environment on a day-to-day basis. We were told how toilet paper and towels have not been sufficiently accessible to residents. Steps taken to overcome this do not demonstrate that the service is always run in the interests of service users or that it promotes either their dignity or a homely environment. We can see that following a meeting with us in October 2007, the Registered Manager improved her attendance at work. However this has reduced again since March 2008. Lack of management is holding the service back and there is an apathy that needs to be addressed. We have agreed that the service will ensure we receive an application to register a new manager by no later than the end of November 2008. Failing this, we will seek advice about the options available to us. 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. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5. Quality in this outcome area is adequate. Some people do not feel they have been provided with enough information to help them decide whether to move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Before admitting a new resident, we can see that steps are taken to gather information about the prospective resident from different sources. The person is also offered a trial visit. This helps the service to decide if they can meet the needs of the person applying for a place. Before admission the service does not write to applicants to confirm that following assessment they are confident they can meet their needs. The information obtained was not used to assess and minimise significant risks. People do not always feel they have a real choice about moving in; telling us there was nowhere else for them to go. People have told us in surveys and in person that they did not have enough information at admission stage to help them decide whether they wanted to move to Charter House. A new service user told us they had not received a brochure about the home. Staff said this had been provided. However systems have not been developed to evidence this. We advised that a simple system be devised to obtain the persons Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 10 signature by way of receipt for any brochures or other regulated written information provided. Information that should be available to new service users has not been updated since 2006 and does not include sufficient information about weekly fees or the charging process. In addition, the new resident had also not been issued with a contract informing of the rights and responsibilities of all parties. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is adequate. People’s needs are mostly met and they are supported to be independent. Guidance however is not available to inform staff about all significant needs and risks. People make decisions about their lives on a day-to-day basis but could be better consulted about the running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at Charter House have told us that they are happy living at Charter House and happy with how they are supported. Perusal of care plans show that guidance available to staff is detailed in respect of those needs identified. However, some significant needs identified in pre admission information available to the home were not included in plans of care or risk assessments. One resident raised a concern with us at inspection which staff and managers were not aware of. The local Community Mental Health Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 12 Team has investigated this. The outcome supports feedback we gave the service about the need to develop the risk assessment and care management plan so staff know how to address sensitive issues pertinent to that service user. We can see however that there have been regular review meetings with the placing professional and communication between the parties is good. In surveys residents tell us they are satisfied with choices available to them. The resident we spoke to expressed less satisfaction about a range of choices including food and retiring times. Detailed records show how food choices are offered. He told us how he has not expressed some of his concerns to representatives at the home and did not know how to complain. He said how residents meetings take place but he chooses not to go. We discussed residents’ meetings with staff. We were expecting to find that the frequency had reduced in accordance with service users’ wishes as this had been raised with us at the last inspection. The frequency had not been reduced as the decision had been taken to discuss it with Inspectors again at this inspection. Staff told us how residents are not very motivated to attend the meetings. From the minutes we could see why. The process is very one way, with little opportunity for residents to influence the way the service is managed. When queries are raised, about for example, holidays, actions agreed are not followed through and fed back so service users cannot see the point in attending the meetings. We pursued the holiday theme arising within the minutes. Service users have not been on holiday to date this year. A service user told us she was disappointed about this as she had enjoyed last years holiday and it is ‘probably too late now’. It is thought that a caravan holiday may be offered for those wanting to go, chosen by staff, with no alternative destinations. Therefore, there is scope for improving service users’ choices and how they are supported to be involved in all decisions relating to the running of their home. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is adequate. Activities are available and people decide on a day-to-day basis what they will do. Residents’ religious needs are respected and their diverse beliefs are encouraged and supported. There is room to provide improved opportunities in some areas to meet individuals’ interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We can not see how anything has changed since the last inspection for people living at Charter House. At the last inspection we judged leisure quality to be ‘good’ on the basis that peoples dissatisfaction with day care arrangements had been identified and were we were assured subject to review. The service’s recent annual return tells us that ‘some of our service users have requested additional day service options albeit in the immediate surrounding area. This is a topic we are currently researching as a result of promoting choice and Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 14 independence.’ Lack of progress over the last twelve months in addressing residents dissatisfactions have minded us to change the overall rating to ‘adequate’ as proposals for improvement have not been followed through. We were told people continue to opt in or out on a day-to-day basis of the same activities that were available to them last year. We are aware that people are relatively independent and can come and go as they please. However, there is no further evidence that the home is taking steps to support residents to enjoy their individual interests and hobbies on a one to one person centred basis. Leisure opportunities continue to be resource rather than needs lead at Charter House. We are satisfied that residents have access to friends and family whom they visit, receive visits from and can telephone from the available pay phone if they wish to. Service users have not been on holiday this year and although managers are considering offering a caravan holiday possibly in October, there has been little consultation about this and no alternative options made available. Robust record keeping has helped Charter House to demonstrate how it offers food choices for one resident who has repeatedly grumbled about this. Staff are aware of service users dietary needs. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. Some aspects of medication management could improve to ensure greater accountability and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most people living at Charter house are physically able and require just prompts from staff to carry out their personal care. The person whose care we looked at in detail told us that staff enable him to manage his personal hygiene independently as he wants them to. The care plan confirms the need for staff to only provide verbal prompts. His dissatisfaction was in relation to the environment saying it is ‘not nice’ when a person is undressed in the bathroom for there not to be blinds or curtains at the window, or to have to use green paper towels instead of toilet paper or tissue instead of a bath Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 16 towel. He also pointed out how, when upstairs it is not possible to access a toilet when someone else is in the bath as the only other upstairs toilet is locked and reserved for staff. We confirmed these concerns by touring the environment with him. Health care professionals are effusive in their praise of the service Charter House provides. We agree that it is proactive and excellent. After a short time to settle in we could see that a new service user had been supported to register with a range of clinics and had started to receive routine health screening and health checks to monitor and receive treatment for specific diagnosed conditions pertinent to the individual. Any changes in health condition are noticed by staff, recorded and monitored. Records of health care are detailed and are effective. Residents tell us they are happy with how they receive their medication and reviews with medics are held regularly. The home has changed its supplying pharmacist and intends to cut down on waste by not routinely returning drugs prescribed ‘as required’ that are within their use by date. We explained that in this case they will need to ensure records accurately reflect the numbers of individual medications carried forward from one period to the next. We found that stocks of medications for two service users do not tally accurately with medication records. This casts doubt on the integrity of the medication records and administration practice. This serves to limit how the service can demonstrate that it supports residents to receive their medications as they are prescribed to maximise opportunities for health. In both instances, two staff members told us that they feel the discrepancies have arisen from omissions in accounting for medications that exit and are returned to the premises when people go out on social leave. The service is clear from our discussions how this must now be addressed. This also raised the need to carry out medication risk assessments to minimise any evident hazards. Protocols must also be tightened for the use of over the counter or homely remedies. We found that staff had added paracetomol to be taken up to 4 times daily to medication records for one service user currently taking a range of medications. This was not verified for safety with a pharmacist or Doctor as staff ‘took the service users word for it’. This risks ill health from a mix of drugs reacting badly together or risks potentially inadvertent overdose. All staff administering medication have been trained and we were told there have not been any medication errors or incidents. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. Not everyone who lives at Charter House knows how to complain. The service is aware of this and remedial steps have not been taken. People living at Charter House do not always feel listened to. The management of service users monies has improved and is now safe although people’s financial vulnerabilities have not been assessed and recruitment practice is also failing to protect people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection, we confirmed information available to us in the annual return that there have not been any of the following: complaints, adult protection referrals, investigations, referrals to the national Protection of Vulnerable Adults list, admissions to Accident and Emergency departments, deaths or restraints. The homes has analysed the results of it quality assurance surveys and from this have concluded that 65 of residents know how to complain. They have not used this information to recognise that this also means that 35 do not know how to complain so no action has been taken or has been planned to address this. Two service users told us separately that they do not know how to complain and said they don’t feel their comments are listened to and acted upon. Minutes show us that residents meetings are currently not a two way process and residents are not motivated to attend. Information about how to complain and reassurance about how complaints will be dealt with is not Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 18 available in public areas of the home and has not been explained in residents meetings. We have already discussed how care plan systems should be developed to ensure staff know how to meet all service users significant needs. This would help to prevent situations arising which may provoke the need for complaint and in the situation to which we are referring, cause a service user to say they felt abused and unsafe. This has been investigated independently since this inspection. The conclusion was not that there was abuse but insensitive communication arising from lack of information available to staff. The services annual return to us recognises the need to improve aspects of complaints and protection systems. We looked at accident and incident records. There have not been any accidents and only one incident since the last inspection. A service user became physically and verbally abusive and Police were called. The situation soon calmed and was resolved. The Community Mental Health team were informed although we were not informed under regulation 37. Service users monies are now managed well: Following concerns we identified at the last inspection, Social Services have visited the home to look at practice. The following improvements have been noted. • • • • • • • • Monies have been individualised and are no longer pooled, Money is now held in one place, Records of expenditure are completed, Two staff and the resident sign for all transactions The deputy manager and the registered manager check records regularly Service users monies are not being temporarily borrowed to meet the homes or other expenses Money belonging to a service user is not now paid into the business account, we were told The cash in hand held tallied accurately with records for all service users whom the home supports to manage money. At a meeting with us in October 2007, the registered manager also agreed to ensure that plans of care for the management of each service users finances are put in place. Staff agreed that this is still in place for only one service user. The service user whose care we looked at it is known to be financially vulnerable and to have been exploited in the past. Neither care plans nor risk assessments have been developed to consider and reduce the known risks. Most staff have done adult protection training. Of two new staff, one has received adult protection training, with one still needing to do this. Whistle blowing has been discussed with new staff and a new staff member could describe to us her responsibilities. The way new staff are recruited is not protecting service users and is discussed more fully under ‘Staffing’. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is adequate. The home is comfortable and people living at the home like their bedrooms. There has been some improvement since the last key inspection, with more planned. Failures to replenish fundamental facilities such as toilet paper reduce the homeliness of the environment and compromises resident’s dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents living at Charter House are physically able and so aids and adaptations or special facilities are not required to meet people’s needs. The finish internally is worn and gradual improvements made do not address this impression overall. There has been some redecoration and new flooring has been laid in a number of communal rooms. Also mattresses and duvets have been replaced which in part has positively addressed the previous malodour evident last time in some rooms. The additional benefit is that this limits the risk of infection to staff and residents. We found however, no soap available Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 20 for use in the laundry, which does not seek to proactively limit the risk of infection when people are handling soiled linen. Further improvements to the environment are planned for completion by the end of 2008 including external areas to the front and back of the property, which remain unkempt currently. The deputy manager said that he would address matters raised with us such as the absence for days on end of toilet paper, bath towels and the lack of window dressing at communal bathroom windows. A service user told us it is ‘not nice’ being undressed in the bathroom without their being a window covering. We were also told that the practice of reserving for staff by locking the only other upstairs toilet would be reviewed. A service user expressed concern about this, as there is no other available toilet upstairs when the bath is occupied. People’s bedrooms are comfortable and are personalised. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35. Quality in this outcome area is adequate. People living at Charter House are generally happy with the staff approach to them although we were informed of one concern. The recruitment of new staff however is poor. Inadequate checks on new staff prior to employment are putting residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents speak highly of staff. A system for planning and monitoring staff training is not in place but staff are receiving training and there is no concern about staff competence. Staff, including new staff are receiving regular supervision and a new staff member we spoke to has found her induction to be helpful. From discussion with staff we found out that someone who used to work at Charter House is providing staff with supervision in their own homes and with the increasing absence once more of the registered manager, is taking on some staff development responsibilities. Since the last inspection, one staff member has left but two have been appointed. This provides an additional staff member and greater flexibility amongst the team to cover absences. The deputy manager feels this has Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 22 positively impacted on him, as he is no longer working seven days a week. The rota confirms that he is having a rest day. We looked at the files of two staff recently recruited and found recruitment processes to be poor and failing to protect service users. For the first new staff member none of the required checks to confirm the person’s suitability to work with vulnerable adults had been obtained prior to commencing in employment. With the exception of references, none of the required checks had been sought for a second starter either (this includes POVA first, Criminal Record Bureau checks and confirmation of medical fitness). In respect of the first starter, we looked at the rota. The rota leads us to believe s/he worked alone and unsupervised at times before appropriate checks were received. Discussion with the deputy manager and the staff member challenges this assumption. The deputy manager explains he had failed to adjust the rota to accurately represent changes to staffing on these occasions. The staff member cannot recall ever being left to work alone. However we agreed with the service representative present that this practice is poor and doesn’t protect people living at the home. We have reminded the deputy manager again that it is not acceptable for rotas to be written in pencil. This is not accountable. They should be in indelible ink with any required changes made clearly showing planned and actual shifts worked. Bank staff must also be named on rotas, and not referred to as ‘bank’. This does not demonstrate who has been working on the premises and again is not sufficiently accountable. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is adequate overall although performance is very mixed. There are some repeated fundamental concerns about the management of the home. The Registered manager through absence is not able to discharge her responsibilities and the home is not always managed in the interests of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service continues to be rated as ‘adequate’ with elements of its practice ranging from excellent to poor. Staff present as cooperative and competent in a service that lacks management and energy, with little drive to improve. At the last inspection we provided detailed feedback about the homes quality assurance tool but at this inspection could see no material change to it. It is Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 24 not helping the service to improve, is not affecting outcomes for service users and is not designed to effectively achieve this. For example it does not address day care opportunities, an ongoing source of some dissatisfaction for some service users. It also does not address the findings that 35 of residents do not know how to complain. The service’s annual return to us could also form part of their quality assurance system. It is a legal requirement that this is provided to us by the date we request it. It was supplied to us late and two dates for compliance were missed. At the point when a Statutory Enforcement Notice was being prepared, the AQAA was received. It does not identify shortfalls we have found. For example, significant concerns have been identified about recruitment practice. The AQAA does not refer to recruitment at all. We have identified shortfalls in written guidance available to staff in care planning and risk assessments. The AQAA states ‘Charter House prides itself on keeping well-documented files/assessments on each service user. This is done on an individual basis, which is reviewed regularly. Our risk assessments are kept up-to-date, and monitored’. The manager’s attendance at work is poor and following some initial improvement after a meeting with us in October 2007, this has reverted again. Staff and service users relate to the deputy manager as the boss and refer to the registered manager as ‘popping in from time to time’. This is insufficient with initial improvements now shown as unsustainable. We have agreed that a completed application to register a new manager must be sent to us by the end of November 2008. Only one staff meeting has been held since after November 2007 and the registered manager was not present at this. We sampled aspects of service maintenance where previous omissions were identified. Positively, we could see at this inspection that the water supply has been chlorinated to reduce the risk of legionella and that hot water is available without problem. The electrical wiring has also been recently checked for safety. Certification was available for this and lasts for 5 years. Risk assessments for hazardous products have also been updated. A Fire Officer has not visited the premises since the last inspection but Telford and Wrekin have carried out a food safety inspection and have awarded Charter House a 3 star rating meaning they consider food safety practice to be ‘good’. A staff member we spoke to who feels the service is ‘good’ has no concerns about how the home is managed. We were told Charter House provides ‘adequately for service users needs and promote independence as much as we can’. Another staff member felt the home should be rated as ‘adequate’ given the shortfalls identified on this occasion. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 3 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 4 2 X 1 X 1 X X 3 X Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19 Requirement The registered person must not employ a person to work at the care home unless the person is fit to work at the care home and he has obtained in respect of that person all documentation required by regulation to assure that s/he is suitable to work with vulnerable people. This is to ensure the protection of vulnerable people. New requirement September 2008. The Registered person must review the current Management arrangements for the home. Requirement arising from random inspection 12.2.07 with target date of 31.3.07 and not met at September 2007. Not met at inspection September 2008. (We agreed a completed application to register a new manager will be submitted to us no later than the end of November 2008) Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 27 Timescale for action 12/09/08 2. YA37 9 12/09/08 3. YA41 37 The Registered person must 12/09/08 give notice to CSCI without delay of the occurrence of any incident as defined in Regulation 37 1(a) to 1(g) and any notification given orally must be confirmed in writing. New requirement arising from random inspection 12.2.07. No notifiable incidents by September 2007. Not met at this inspection September 2008. 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 YA1 Good Practice Recommendations The Statement of Purpose and Service User Guide should be reviewed and should include the weekly fee. These should be made available to all service users and to new service users pre admission. Ways of evidencing the provision of these regulated documents should be considered. 2 YA5 New recommendation September 2008. A contract outlining the terms and conditions of residence should always be provided to people living at Charter House at the point of admission. New recommendation September 2008. Guidance should be available in care plans and risk assessments for all significant needs and risks to help staff know how to meet needs and limit risks to service users. DS0000020543.V371754.R02.S.doc Version 5.2 Page 28 3 YA6 Charter House 4 YA7 New recommendation September 2008. How service users are offered choices and involved in the running of the home should be reviewed and improved. New recommendation September 2008. All service users should be supported to pursue their own interests and hobbies. Plans should be in place for example to support attendance at football matches through effective budgeting and the flexible provision of staff. New recommendation arising from inspection September 2007. Not met September 2008. 5. YA14 6 YA18 Suitable arrangements should be made to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. This includes (but may not be restricted to) the provision of blinds or curtains in the bathroom and ensuring that toilet paper and bath towels are readily accessible at all times 7. YA20 New requirement September 2008. Advice should be sought from the dispensing pharmacist about the practice of double dispensing. New recommendation arising from inspection September 2007. Not met at this inspection September 2008. 8 YA20 Steps must be taken to assess and minimise any risks posed by the self-administration of medication. This will enable residents to maintain their independence safely. Requirement arising from inspection September 2007. Not met at this inspection September 2008. 9 YA20 Steps should be taken to improve accountability in respect of medications that leave and return to the premises when people have social leave. Also, steps must be taken to assure the safety of administering over the counter or homely remedies prior to doing so. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 29 These steps will ensure the home can demonstrate that medications have been administered as prescribed in the interests of service users health and safety. Also that all reasonable steps have been taken to avoid the risk of contraindications between medications and or inadvertent overdose. 10 YA22 New recommendation September 2008. Steps should be taken to ensure that all service users know how to make a complaint and the procedure that will be followed in the event of a complaint. This will ensure that dissatisfactions are made known and resolved to improve the service users experience of care and to enable the service to learn and develop from complaints made. 11. YA28 New recommendation September 2008. External grounds should be appropriately maintained. New recommendation arising from this inspection September 2007. Not met at this inspection September 2008. 12 YA39 The home should develop and maintain an effective quality assurance and monitoring system. This requirement is part met at inspection 12.2.07. Target date set for 31.5.07 and at September 2007 remains part met. No progress at this inspection September 2008. Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Charter House DS0000020543.V371754.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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