Inspection on 12/02/07 for Chase House

This inspection was carried out on 12th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chase House 11/03/08

Chase House 01/03/06

Chase House 01/09/05

Chase House 09/03/05

Chase House 22/09/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Chase House 95 Chase Road Brownhills Walsall West Midlands WS8 6JE Lead Inspector Ms Maggie Bennett Key Unannounced Inspection 12th February 2007 09:35 Chase House DS0000020846.V325975.R01.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 Chase House DS0000020846.V325975.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 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. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chase House Address 95 Chase Road Brownhills Walsall West Midlands WS8 6JE 01543 252063 01543 300399 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 Angela Lane Mr Peter David French Acting Manager, Mrs. Denise Suffolk Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2006 Brief Description of the Service: Chase House provides care for four people with autism. The service is designed to meet the continued education needs of service users through their development into adulthood. Chase House offers structured activities and full use is made of community based provision. The property is set back from the main road on the outskirts of Brownhills. All bedrooms are single, each service user having been involved in choosing the decor and furniture. The garden area is small, with a patio and lawned area. A new conservatory has recently been constructed. There is a drive to the front of the property with very limited parking. Fees charged at the home are £1,035.07 per week. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on a weekday between 9.35 a.m. and 6.25 p.m. Prior to the inspection a Pre Inspection Questionnaire was completed by the Acting Manager of the home and returned to the Commission. Surveys were sent to the service users’ families and two of these were returned to the Commission. At this inspection all the key standards of the National Minimum Standards were assessed. At the last inspection, in March 2006, a total of 4 statutory requirements were made. All those requirements have now been met. 9 statutory requirements were made on this occasion. 5 good practice recommendations have been made. Since the last inspection the Registered Manager has moved to another home within the Company. Currently there is an Acting Manager in place, who will shortly be making application to the Commission for Social Care Inspection to become the Registered Manager of the home. During the course of the day the care plans of 2 of the service users were seen in order to assess the home’s care planning practice. Daily notes were seen which showed the wide variety of educational and leisure activities provided for the service users. The medication and accompanying administration records were inspected. A number of staff files were inspected in order to assess the home’s recruitment procedures and provision of staff training. A tour took place of the building. All the service users were at home during the day and, although none have speech, there was the opportunity to observe their interaction with staff and the daytime activities. 2 staff members were spoken to and discussion took place throughout the day with the Acting Manager of the home. A telephone discussion took place with one relative. What the service does well: No new service users have been admitted to the home since it was first opened. There are, however, sound assessment procedures in place which ensure that any new service user could be assured that the home would be able to meet their needs. Key planning is of a good standard, with each service user having an individual plan developed using person centred planning principles. There is evidence that service users are supported to make decisions in their daily lives, within a risk assessment framework. Service users are provided with a wide variety of opportunities to enable them to develop their skills and confidence. Family links are regarded as a high priority and each week service users are assisted to send letters home, sometimes using the e mail facility. The food provided is balanced and nutritious and caters for any cultural needs. There is evidence that service users’ privacy and dignity is very much respected at Chase House and personal care is delivered according to the requirements of the individual. The building itself is warm and Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 6 comfortable. On the day of the inspection staff were observed to have an excellent rapport with the service users. Despite a difficult period involving staff changes and building work, the Acting Manager and senior staff have shown great commitment and it is to their credit that the service users have continued to receive a very high level of care, appear calm and happy and have not been unduly affected by the changes. Comments received from relatives were very complimentary: “…..are very pleased with the care and attention she gets there. Also it is a very good homely environment. The staff are excellent.” “I am quite happy with the home.” What has improved since the last inspection? What they could do better: There are some issues where the home could do better, but it needs to be stated that the Acting Care Manager took on the responsibility of running the home at a difficult period and has had to prioritise. This has meant that some areas have fallen behind. Care plans are clear and person centred and the “My Life” books provide the care planning in an accessible format. These have not, however, been completed in several areas and this needs to be done so that service users are involved in their care planning. The major area for improvement is staff training. Although several staff have taken part in one day medication training, this is not considered to be sufficiently in depth. Guidance on the required training can be found on the CSCI website and on the Skills for Care website. All new staff need to take part in LDAF accredited induction training, which is to Skills for Care specifications. Steps also must be taken to ensure that all staff have up to date training in first aid, moving and handling, food hygiene, fire safety and infection control. Staff must also receive training in Adult Protection and equal opportunities. At the time of the inspection there was no training and development plan in place. This must be developed and a copy forwarded to the Commission. Both the fire risk assessment and risk assessments for the building need to be reviewed and updated where necessary. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 7 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. Chase House DS0000020846.V325975.R01.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 Chase House DS0000020846.V325975.R01.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): Standards 2 and 3. Quality in this outcome area is good. There are sound assessment procedures in place at Chase House, which ensure that service users’ needs are met. The individual needs of service users are evaluated and met as far as possible, with relevant training and specialist professional advice being obtained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No new service users have been admitted to Chase House since 1999. There is evidence from care plans that all the service users received the benefit of a full assessment before moving to the home. All service users have individual care plans, which include risk assessments. (See Standard 6). The home is able to demonstrate through its records and care plans that Chase House is able to meet the assessed needs of the service users. Staff receive relevant training and various methods of communication are used to suit individual service users. This includes Makaton. The specific cultural needs of one service user are clearly documented and upheld. Respite care is not provided at Chase House. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 10 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): Standards 6, 7 and 9. Quality in this outcome area is good. Each service user has an individual plan of care, which has been developed using person centred planning principles. As far as possible service users are involved in their care planning, although recent key-worker vacancies have resulted in some delays to the completion of the “My Life” books. Management and staff understand the importance of service users being supported to make decisions in their daily lives and enable them to make choices. Risks are assessed and where limitations are in place, these decisions have been made in the best interest of the service user. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 11 All of the service users have an individual plan of care. Two of the care plans were looked at in detail during the inspection. The care plans follow the principles of person centred planning. The present care plans contain a clear picture of the individual, which includes management guidelines detailing individualised interventions for each person. They also include the daily routines preferred by each person. A Personal Communication Plan informs the Care Plan by providing a checklist of each person’s communication skills. Care plans also contain details of procedures to manage any aggressive or harmful behaviour. Each care plan contains a risk assessment. Care Plans are reviewed every six months and updated to reflect any changing needs. “My Life” books have also been introduced, which operate alongside the care plans. These books are compiled with the service user and are in accessible formats. The books are retained by the service users and kept in their own rooms. It was found at the inspection that the “My Life” books had not been completed in all areas. This included details of activities the person had undertaken, healthcare needs and the section entitled “What I can do”. It is the home’s intention to produce pictorial descriptions in the books with the use of “widgets”, but this has not yet taken place in all cases. The Acting Manager stated that the “My Life” books were usually completed by the service user, with assistance from their key-worker, but that at present there were some key-worker vacancies. Service users’ personal likes and dislikes are recorded in their care plans and they are enabled, as far as possible, to make decisions about their daily lives. There is evidence from care plans that staff assist service users to make decisions, using a variety of methods. This can include the use of signs, symbols and photographs. Where individual choices are made, these are recorded in the Day Book for each service user. The Acting Manager gave examples of how a particular service user chooses and indicates to staff whether they wish to have a shower or a bath. Another example was given of a service user wishing to play a musical instrument and how staff enable him to indicate his wishes and provide the opportunity he wants. During the inspection service users were observed to be making choices throughout the day in terms of the activities they took part in and, in the case of one service user, the time she got up and took breakfast. There was evidence from the management guidelines in the care plans that the home recognises its responsibilities to limit choice on the rare occasions that this is necessary when it is in the person’s best interest. Where the registered person acts as appointee, appropriate records are kept. Each service user has their own individual bank account and these records are kept securely. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 12 Risks to service users were assessed prior to their admission and risk assessments are regularly reviewed and updated. Required action to minimise risk is documented in the Management Guidelines. The home has a Missing Person Procedure. Chase House DS0000020846.V325975.R01.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): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. Service users are provided with a variety of opportunities to develop their social skills and confidence. Many of these activities take place in the local community. Service users are enabled to maintain family links and relationships. The rights of the individual are very much respected at the home with service users being encouraged and enabled to make choices. The meals are balanced and nutritious and cater for the differing cultural needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are able to take part in a range of activities organised by the home to help them develop their skills and confidence. There is a daily curriculum, which includes music and movement, horse riding and personal Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 14 skills training. One to one cooking sessions are held, as well as assistance with domestic skills. A service user was assisting with the preparation of the evening meal during the inspection. A number of trips out are organised, which can include lunch out or one to one shopping. On Friday evening service users are assisted to write letters home and this includes sending e mails. Saturday night is often a video or DVD night, when sweets and pop are provided. Service users also attend numerous activities organised at Ferndale Day Centre. All daily activities are clearly recorded. A number of activities take part in the local community, such as swimming, shops, the pub and shops. Quite often public transport is used. Staff are aware of the service users’ rights of access under the Disability Discrimination Act. The home enjoys good relationships with its neighbours. Staff time with service users outside the home is recognised as part of their duties. In the summer of 2006 service users enjoyed a successful holiday to Wales and a repeat trip has been arranged for June 2007. Care plans seen and discussion during the inspection show that the maintenance of family links and friendships are very much encouraged at Chase. Family and friends are welcome at any time and arrangements are made for the service users to spend time with their families. There is the opportunity to make new friends at the various clubs visited. There are clear policies and procedures in place to protect service users, should any individual wish to develop an intimate personal relationship. It was observed during the inspection that staff only enter service users rooms after knocking on the door. All bedrooms have been provided with suitable locks and service users have been offered keys. None have chosen to keep their keys or lock their doors. Any mail to a service user is opened with them. It was observed during the visit that staff and service users interact as a group and staff do not talk exclusively amongst themselves. This includes mealtimes, with staff taking their meals with the service users. Service users have unrestricted access to all parts of the home, within the context of a risk assessment. There are no strict rotas for housekeeping tasks at the home, but service users are encouraged to assist with some tasks. There are clear policies with regard to smoking, alcohol and drugs. Menus seen indicate that service users are offered a variety of nutritious foods. Attention is given to the particular cultural and dietary needs of individuals. Halal meat is purchased for one service user. Very adequate food supplies were seen during the inspection, which included fresh fruit and a variety of frozen foods, which are offered if the main meal of the day is not to a service user’s liking. The food taken by each individual is recorded on a daily basis. Service users are able to assist with food preparation under supervision. The kitchen is domestic in style and was clean and in good order at the time of the inspection. Fridge and freezer temperatures are taken daily and core Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 15 temperatures are taken of all cooked meats. In the past the low weight of a service user has been cause for concern and in this case clear records are maintained, with risk factors identified. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 16 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): Standards 18, 19 and 20. Quality in this outcome area is good. Service users’ privacy and dignity is very much respected at Chase House and personal care is delivered according to the requirements of the individual. Service users’ healthcare needs are clearly recorded on their care plans. The home’s healthcare check-list needs to be updated for some service users. There is an efficient medication administration system and policies and procedures in place to protect the service users. Several members of staff need to undertake appropriate accredited medication training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All personal support to given to service users in private. Currently there is only one male member of staff so it is not possible for male service users to always be given intimate care by a person of the same gender. Times for getting up and going to bed are flexible and service users’ preferred routines, likes and dislikes are recorded in their Care Plans. Service users are assisted Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 17 to choose their own clothes. The home does operate a key-worker system, but recent staff changes have meant that not all the service users have a keyworker at present. The healthcare needs of individuals are clearly documented in their care plans. All care plans contain a Health Plan checklist. In some instances this checklist was in need of updating. All service users regularly attend either the Well Woman or Well Man Clinic. Service users all have the same G.P. and where possible, visits to healthcare professionals take place in the community. The G.P. arranges regular health checks, including a medication review. None of the present group of service users are able to manage their own medication. The home uses a monitored dosage system. The medication is locked securely and appropriate records are kept of all medicines received, administered and leaving the home. It is recommended that all care plans contain an up to date record of the current medication for the service user. The home’s procedure is to dispense the medication into pots, take these and the administration record sheets to the kitchen, lock the tablets immediately in another cupboard and then ask service users to go to the kitchen for their medication. The administration record sheet is signed when the staff member has witnessed the person taking the medication. There has been some turnover of staff since the last inspection and some of the staff who now administer medication have not taken part in the required medication training. Some have undertaken a one day accredited foundation course, but this is not considered to be sufficiently in depth. The Acting Manager must ensure that all staff who administer medication have taken part in appropriate accredited medication training. Guidance on this can be obtained on the CSCI website under the guidance logs and on the Skills for Care website. The Acting Manager carries out a regular audit of the medication and records and assesses staff competency. In addition the Pharmacist carries out an audit. The last Pharmacy audit was in September 2006, when the system was found to be working satisfactorily. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 18 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): Standards 22 and 23. Quality in this outcome area is good. There is an up to date complaints procedure in place and service users are provided with pictures and symbols indicating how they can express their views if they are unhappy about anything at the home. There are satisfactory Adult Protection Procedures in place to protect the service users from abuse. Some staff need up to date training in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chase House has a clear complaints procedure in place and this is available in an accessible format. None of the present service users have speech, but it was observed during the inspection that staff use a number of different ways of communicating with the service users. There are various symbols and pictures around the home indicating how complaints can be made. The procedure now contains the correct address and telephone number of the Commission for Social Care Inspection. No complaints have been received by the home or by the Commission since the last inspection. The home have clear procedures in place for responding to any suspicion or evidence of abuse or neglect. At the time of the inspection the home were in the process of obtaining a copy of the updated Walsall Social Services Adult Protection Procedures. Issues with regard to Adult Protection are covered in Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 19 NVQ and LDAF training. The Acting Manager demonstrated a good understanding of her responsibilities with regard to the Protection of Vulnerable Adults and has recently attended a Conference on the subject. The home have clear policies in place with regard to physical or verbal aggression from a service user. Not all of the current staff have received training in physical restraint and it is therefore not the home’s policy to use physical intervention. As there are several relatively new members of staff at the home, training in Adult Protection for these staff needs to be arranged as a matter of priority. All service users have their own bank accounts, into which their personal benefits are paid. The Registered Person acts as appointee for 2 of the service users. The home keep service users’ cash in safe keeping in individual wallets, with accompanying records. The cash and records are regularly checked by the Acting Manager and the finances are audited by the company’s Care Coordinator on a monthly basis. A check was made of the monies and records of 2 service users and both were in order. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 20 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): Standards 24 and 30. Quality in this outcome area is good. Chase House is comfortable and well maintained and provides a pleasant and safe home for the service users. The home is clean and there is a good infection control policy in place to protect the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chase House is an older, detached property, which has been modernised and refurbished over the years. It is domestic in style and has a homely and comfortable atmosphere. All service users have their own single room and there is a large lounge/dining room on the ground floor. There is a bathroom and toilet on the first floor and a shower room with toilet on the ground floor. A number of improvements to the environment have been made since the last inspection. Wash-hand basins have been fitted to all bedrooms and all service Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 21 users’ rooms have been fitted with suitable locks and keys provided. The bathroom has been re-decorated and new carpets have been provided in all the bedrooms. At the time of the inspection tiles were being repaired in the ground floor shower room. The kitchen has also been re-decorated. A conservatory has been added to the rear of the property and a separate staff toilet installed. The garden is to be landscaped. These additional facilities will be of great benefit to the service users. At the time of the inspection the home was clean, warm and comfortable and free of any offensive odours. Bedrooms are comfortable and attractive and service users’ have been very much involved in choosing colours, furniture and accessories. The laundry is beyond the kitchen, but the home have clear policies and procedures in place to prevent the spread of infection. At the time of the inspection the laundry was clean and in good order. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 22 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): Standards 32, 33, 34 and 35. Quality in this outcome area is adequate. There has been a high staff turnover at Chase House in the past year and some long-term sickness, but the experienced staff have worked hard to ensure the minimum effect to service users, who appear settled and happy. Staff rotas take into account the needs of routines of the service users. The departure of the Training Co-ordinator and recruitment of new staff has meant that there are gaps in training which need to be filled in order to ensure that service users are cared for by a well-trained and competent staff group. There are robust recruitment procedures in place, which protect the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection staff were observed to have a very good rapport with the service users. There have been a number of staff changes recently and not all of the staff have yet received specialist LDAF (Learning Disability Awareness Foundation) and Autism training. 3 of the service users use Makaton and the Acting Manager is currently training the staff who do not have this skill. The Acting Manager states that she has ensured that night staff receive particular Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 23 training in communication with regard to toileting needs and the way that service users indicate that they may be in pain. There is evidence that new staff have taken part in initial induction training, but the Acting Manager must ensure that all new staff achieve the LDAF accredited induction training to Skills for Care specifications. At present the home does not have 50 of its staff trained to NVQ level 2 or above. 3 members of staff are currently working towards the Award and when this is achieved the Standard will be met. During the daytime (7.30 a.m. to 10.00 p.m.) there are always 2 members of care staff on duty. The Acting Manager’s hours are supernumerary. At night there is one waking night staff. As stated above, there have been a number of staff changes recently and in addition to this, there are 2 members of staff on long-term sick leave. This has necessitated the use of the home’s “bank” staff. Agency staff are not used. The last staff meeting took place in October 2006 and the Acting Manager states that it is her intention to improve this and ensure that a minimum of six staff meetings take place each year. Not all of the present staff group have been trained to use Makaton, but this training is currently taking place. Staffing levels are regularly reviewed to reflect the needs of the service users and additional staff are brought on duty to cover medical appointments, trips, etc. The files of 4 members of staff were seen in order to assess recruitment practice. In all of the files seen there were 2 written references and verification of satisfactory Criminal Records Bureau and Protection of Vulnerable Adults checks. Application forms were on file. 3 out of 4 of these contained a full employment history. On one form the applicant had written “various Home Care companies”. The home must obtain full employment histories from all applicants. All staff have been given copies of the General Social Care Council Code of Conduct. Files also contained details of the staff’s statements of terms and conditions. All new staff at Chase House are subject to a six monthly probationary period. At the time of the inspection a training and development plan was not available. Each staff file seen, however, did contain an individual training and development assessment. In the past staff training at Chase House was organised by the home’s former manager, who was also the company’s Training Co-Ordinator. He has, however, given up this role and training for staff at Chase will now be organised by the Acting Manager. From observation of staff files it could be seen that several staff, particularly those who have been most recently recruited, are in need of training in the mandatory health and safety areas (see also Standard 42), as well as training in medication administration (see also Standard 20) and Adult Protection (see also Standard 23). All new staff must undergo structured induction training within six months of appointment to Skills for Care specifications. Some staff have not yet received equal opportunities training. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 24 From observation of the daily records and service user/staff interaction service users do not appear to have been disadvantaged by the recent staff changes. It is clear that the experienced staff at the home have worked professionally and effectively during this period and have “gone the extra mile” to ensure minimum disruption to the service users. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 25 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): Standards 37, 39 and 42. Quality in this outcome area is adequate. The Acting Manager is experienced and has shown great commitment in bringing the home through a difficult period, which has included staff changes and changes to the environment. It is to her credit and the staff group as a whole that service users have continued to receive a high level of care during this period. More work is needed on the development of a quality assurance and quality monitoring system. There are sound policies and procedures in place to protect the health and safety of service users and staff. Staff training in the core health and safety areas needs to improve so that service users are fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 26 At present there is an Acting Manager at the home. She has worked at Chase House for 6 years, undergone relevant training and demonstrates an excellent understanding of the needs of the service users. The Manager is currently undertaking the NVQ4 Award and is to follow this with the Registered Managers’ Award. She intends to make application to the CSCI to become the Registered Manager of the home. Staff spoken to during the inspection felt very well supported by the Manager and a relatively newly recruited member of staff said that she would have “no problem” approaching the manager with any issue. The Acting Manager is recommended to ensure that her job description covers all those areas listed in Standard 37.3 and that she is fully conversant with all these responsibilities. Although the home was working towards the development of a quality assurance and quality monitoring system at the last inspection, this has rather “ground to a halt” of late, mostly because other areas, such as staffing and building work have taken priority. In the past questionnaires were sent out by the Service Co-ordinator, but this will now be done by the Acting Manager. A verifiable method of self-monitoring must be introduced at the home and an internal audit must take place each year. The home must produce an annual development plan, which reflects aims and outcomes for service users. It is clear, however, that staff regularly seek the views of the service users about life in the home in a variety of ways and examples of this, such as how service users are assisted to make choices about activities, were available in care plans. The home’s policies, procedures and practices are regularly reviewed. As stated in the Standards on Staffing (above), although the longer serving staff at the home have the appropriate health and safety qualifications, a number of the newer staff need to take part in moving and handling, first aid, fire safety, food hygiene and infection control training. Fire alarms are tested weekly, the emergency lighting each month and fire drills take place at least every six months. Evidence was seen that the fire fighting equipment was serviced in May 2006 and the fire alarm system checked and serviced in October 2006. The home’s Fire Risk Assessment needs to be updated in line with new legislation. Risk assessments for the building also need to be updated. It is recommended that the Acting Manager attend the West Midlands Fire Service training course for Residential Care Managers. All hazardous substances are locked securely. During the inspection evidence was seen of the regular servicing of the gas system and boiler. The electrical equipment at the home was being tested during the inspection. Water temperatures at outlets accessible to service users are regularly tested. Testing for legionella did not take place during 2006 and the Acting Manager states that this is to be arranged as a matter of urgency. As stated above in the Section on Staffing, all new staff must receive induction training to Skills for Care specifications. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 27 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 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 28 No. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement Timescale for action 30/04/07 2 YA32 3 YA34 4 YA35 5 YA35 YA42 All staff who administer medication must take part in appropriate accredited medication training. Guidance on this can be obtained on the CSCI website on the medication guidance log and on the Skills for Care website. 18(1)(a)(c) All new staff must take part in LDAF accredited induction training, which is to Skills for Care specifications. 19 All new staff applicants must supply a full employment history. Any gaps must be explored with the applicant. (“Various home care jobs” is insufficient information). 18(1)(c) The home must produce a staff training and development plan. A copy of this training plan must be forwarded to the Commission. 18(1)(c) All staff must hold up to date training certificates in: first aid, moving and handling, food hygiene, fire safety, infection control. Staff must also be trained in 30/04/07 12/02/07 31/03/07 30/04/07 Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 29 Adult Protection issues and equal opportunities. The above is particularly pertinent to the staff who commenced employment in 2006. The home must produce a quality assurance and quality monitoring system in order to regularly review the quality of care provided. An annual development plan must be produced, which reflects aims and outcomes for service users. The home’s Fire Risk Assessment must be updated in line with new legislation. Risk assessments for the building must be reviewed and updated. The water must be tested for legionella on a regular basis and the system disinfected. (This was being arranged at the time of the inspection). 6 YA39 24 31/05/07 7 8 9 YA42 YA42 YA42 23(4) 13(4) 13(3) 31/03/07 30/04/07 31/03/07 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 YA6 Good Practice Recommendations It is recommended that the completion of the “My Life” books be resumed as soon as possible and that if a particular service user does not have a current keyworker, another member of staff be requested to undertake this task. It is recommended that the healthcare check-lists be updated. It is recommended that all care plans contain an up to date record of the current medication for the service user. The Acting Manager is recommended to ensure that her job description covers all those areas listed in Standard DS0000020846.V325975.R01.S.doc Version 5.2 Page 30 2. 3. 4. YA19 YA20 YA37 Chase House 5. YA42 37.3 and that she is fully conversant with these responsibilities. It is recommended that the Acting Manager attend the West Midlands Fire Service training course for Residential Care Managers. Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Chase House DS0000020846.V325975.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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