Inspection on 20/03/07 for Chase House Ltd

This inspection was carried out on 20th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chase House Ltd 30/12/05

Chase House Ltd 28/09/05

Chase House Ltd 29/06/04

Chase House Ltd 02/02/04

Similar services:

Claremont House

Chesham House

Argyll House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Firstlings

Dolphin Court

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

CARE HOMES FOR OLDER PEOPLE Chase House Ltd House Lane Arlesey Bedfordshire SG15 6YA Lead Inspector Mrs Leonorah Milton Unannounced Inspection 10:20 20 March 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chase House Ltd Address House Lane Arlesey Bedfordshire SG15 6YA 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) 01462 731276 01462 731276 Chase House Limited Mrs Deirdre McGuire Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Physical registration, with number disability over 65 years of age (36) of places Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Two service users under the age of 65 years of age may be admitted to the home from time to time in the category of PD or DE. No one under the age of 65 years can be admitted to the home when there are already 2 service users under the age of 65 years accommodated. 30th December 2005 Date of last inspection Brief Description of the Service: Chase House was a two storey Victorian building, which had an extension built on in the style and character of the original building. The home accommodated thirty-six people and provided accommodation in single and shared bedrooms. The majority of the individual bedrooms were situated on the first floor. Two shaft lifts were provided. The lounges and dining facilities were on the ground floor. There was a large conservatory overlooking extensive landscaped gardens that had a very attractive water feature and countryside views. The home was situated within easy walking distance of Arlesey Village, which was on the main bus route from Hitchin to Bedford. The towns of Letchworth Garden City and Hitchin were three and four miles away respectively. The service offered nursing and social care to older people including those with a physical disablement or dementia. A wide range of activities and excursions including holidays was available to service users. Staff would help organise these breaks and accompany service users as necessary. Fees for accommodation ranged from £425.86 for those without nursing needs to £443.46 for those with nursing needs. The home also cared for service users placed by the Health Service, the fees for which were paid under continuous funding arrangements. Additional charges were made for day trips out of the home, holiday, private chiropody care and dry cleaning of clothes Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report sets out the significant evidence that has been collated by the Commission for Social Care (CSCI) since the last visit to and public report on, the home’s service provision in December 2005. Reports from the home, other statutory agencies, and information gathered at the site visit to the home, which was carried out on 20th March 2007 were taken into account. The visit to the home included a review of the case files for three service users, conversations with these service users; three other service users, three visitors, a visiting doctor and two members of staff. Much of the time was spent with service users in the ground floor lounges, where the daily lifestyle was observed. A partial tour of the building was carried out and other records were reviewed. The manager was present to assist with information throughout the visit and to receive a verbal feedback at its conclusion. The Commission had circulated a questionnaire to service users prior to the visit. Comments from these were taken into account and some are reflected in this report. What the service does well: Service users had received skilled care in comfortable surroundings that were suitable to their needs. The majority of the staff had worked in the home for a considerable time and were well versed with service users’ needs and the home’s daily routines. Records indicated that the team had received a good level of training that had enabled them to properly care for service users. Moreover, the example set by the manager and her senior team had provided the team with an excellent role model for the care of vulnerable people. The home was well managed. Service users had been provided with opportunities to voice their opinions about the service; personnel had been well supported. Service users, their visitors and the visiting doctor all passed much praise about the service and the conduct of the team. One who said that the service “couldn’t be faulted” also stated, “The staff are everything in this home”. Another described the care as “Excellent”. The provision of activities for recreation and stimulation was also excellent. Activities had taken account of service users abilities, preferences and needs. Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 6 A range of activities that catered for those with short term memory loss as well as the more able had been provided and included regular trips out of the home and an annual holiday for the few service users who were able to enjoy an extended trip away from the home. What has improved since the last inspection? What they could do better: 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 Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre-admission assessment procedures had ensured that the home had the capability to care for service users admitted to the home. EVIDENCE: Three case filed were assessed. These showed that assessments of need had been carried out in accordance with the National Minimum Standards before service users had been admitted to the home. Assessments had where appropriate been obtained from placing authorities. There was evidence to show that service users and/or their representative had contributed to these assessments. The home did not provide a rehabilitation service. Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ health, social and personal needs had been well met. EVIDENCE: Three case files were assessed. Each contained a recent evaluation of need and a care plan that sets out how needs are to be met. The plans covered health, social and personal needs. One plan had not been adjusted to reflect a recent significant change in need. However, the daily progress notes indicated that staff were aware of the change in need and were caring for the service user properly. The service user’s relative confirmed the change in care arrangements and praised the staff for having followed the guidance of a physiotherapist and felt that the staff had assisted the service user to regain some mobility following a sudden change in their health. There was evidence to show that service users had been supported to access health care appointments for routine treatments such as chiropody and had been referred to their doctors and other specialists as need be. The visiting Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 10 doctor stated that the “clinical acumen” of the nursing team was of a good standard. He stated that the service he had observed on his frequent visits to the home was excellent. Medicines were stored in a purpose built, lockable trolley that was stored in the office when not in use around the home. Medicines were only administered by members of the team who were qualified nurses. Records inspected showed that medicines had been administered as prescribed with one exception; a service user had been supported to administer their medicine. The record signed by staff however did not differ from the records of medicines that had been administered by members of staff. The home must introduce a record that indicates medicine has been handed over to the service user for self administration. The service user’s wish to vary the times for taking the medicine according to their symptoms must be taken into account on the risk assessment for self-medication. Service users had been treated with kindness and respect. One service user stated that they liked living in the home because “Everyone is very friendly” and described the conduct of members of staff as, “Couldn’t be kinder…we have laughs and jokes”. Another service user said that they were “Treated well and listened to.” A relative of a service user described the members of staff as, “Sympathetic, empathetic and patient”. Whilst there were few records of “end of life plans”, the visiting doctor described the care given to those who died in the home as “excellent”. He stated that he had visited the home at varying times and had found that “A member of staff is always seated with the service user so they are not alone.” Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users had been supported to experience a lifestyle that met their needs and expectations within the limitations of their abilities. EVIDENCE: The home accommodated service users with diverse needs. Arrangements for the day-to-day lifestyle were flexible according to need and preference. Service users’ abilities ranged from one person who was able to walk into the local village to visit shops and pubs alone to others who were dependent of the staff for all their personal care needs. The inspectpr noted the provision of a range of activities for everyone, which included ball games, ad hoc dancing and one to one chats. There were records of other stimulating activities and regular trips out. Records also indicated that service users had been consulted regularly about these activities. Service users and their relatives confirmed that the daily lifestyle seen on the day of the inspection visit was usual. One service user stated “There is lots to do, puzzles, bingo, draughts, dominoes and making Easter bonnets….you can do what you want, if you don’t feel well you can stay in bed, they will fetch your breakfast…you can go to bed when you want…you can have visitors at anytime and they can stay for a meal. Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 12 There is no extra charge.” Visitors commented on the welcome they received in the home. The provision of meals was similarly praised. “Nice food”, “Plenty of it”. A visitor stated that their relative’s physical condition had improved since admission and said the service user had been “eating much better” since admission to the home. Menus seen provided a nutritious choice. Service users who required assistance to take their meals were seen to have sensitive one-to-one support at meal times. Care plans contained assessments of nutritional needs. Records indicated regular monitoring of weight and food and fluid intake where necessary. Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes procedures had enabled service users to raise concerns and protected them from abuse. EVIDENCE: Previous inspections had established that the home had satisfactory written complaints and protection procedures. There had been no complaints about the service for a considerable time. Service users confirmed that they felt able to raise concerns. “They listen to me”, “I say if I am not happy”. There were also regular service users meetings in which service users could comment on aspects of the service such as meals and activities. Minutes of frequent meetings were seen. Three personnel files were assessed. Each contained records to show that robust recruitment practice had been followed that included the checking of employment history through references and checks via the Criminal Records Bureau and the Protection of Vulnerable Adults Register. Records indicated that staff had received training in protection procedures. Staff spoken to demonstrated their understanding of protection procedures and Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 14 their individual responsibility. One said they felt confident that if ever the need arose she would be supported by the home’s whistle blowing procedures. Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises provided a clean and comfortable environment that had been adapted to meet service users needs. The use of a stairwell as a smoking area had not been agreed with the fire service and may have posed a risk to the safety of service users, staff and visitors to the home. EVIDENCE: The communal space and private bedrooms were of sufficient size to accommodate service users. The décor and furnishings were homely and comfortable. The overall effect was pleasant and welcoming. The grounds surrounding the home were well maintained and provided a pleasant place to sit in and look out at. A raised flowerbed was available for service users to tend. Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 16 A service user described their room as “Very comfortable” and the home in general as “You couldn’t want for better surroundings.” Feedback from the pre-inspection questionnaire had included a few comments about the occasional smell of urine from toilet facilities. However, there were no unpleasant odours on the day of the inspection visit. The inspector found all areas of the home seen to be clean and orderly. Information supplied by the provider on the pre-inspection questionnaire indicated that the building and its equipment had been subject to regular service and maintenance checks by qualified persons. Notices were posted to remind staff about infection control procedures. Protective clothing was provided. Clinical waste was properly disposed of. Soiled linen was laundered separately. A tour of the building showed that the fire door to the rear staircase was propped open. It was explained that this area was used by service users for smoking. The fire service must be consulted about these arrangements. The fire door must be kept shut. Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users had been properly cared for by a competent and consistent team. EVIDENCE: Rotas seen indicated that sufficient nursing; care and ancillary personnel were on duty each day and at night. Qualified nurses were on duty to support and guide the staff on every shift, the home having eleven registered nurses and three enrolled nurses amongst its staffing compliment. Information supplied by the proprietor showed that the home had sufficient ancillary personnel to carry out the administration, catering, house keeping and laundry duties. This meant that the care staff had been able to concentrate their efforts on care related tasks rather than domestic and similar duties. The home also had three part-time activity organisers. As noted previously much prise was passed by service users and their representatives about the skills of the team, “The standard of care is wonderful…the staff are so caring.” “Staff are sympathetic and supportive, there is always someone to talk to.” Information provided showed that 67 of the care team had achieved National Vocational Qualifications (NVQ) in care, eight staff having achieved the award Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 18 at level 3. Two housekeepers had achieved NVQ’s in their field. The cook held a City and Guilds award. Three personnel files were assessed and showed as detailed in section four of this report that robust recruitment procedures had been followed. Information seen at the inspection and also provided before the inspection indicated that staff had been provided with a good level of training. This was confirmed in discussion with individual members of staff who showed understanding of their roles and service users’ needs. The training provision for the previous year had covered dementia awareness, protection of vulnerable adults, infection control, moving and handling, fire safety, food hygiene, swallowing difficulties. The inspector was shown a comprehensive induction programme that was in the process of introduction for all new staff. Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users had benefited from a well managed operation that had placed their needs at the forefront of the service. EVIDENCE: The manager was a registered nurse and experienced in the care of vulnerable older people. Service users, their visitors and staff spoke highly of her skills and described her as approachable and supportive. Strategies were in place to enable service users to voice their opinions about their individual care through review meetings and about the daily lifestyle in the home through regular meetings and an annual quality audit of the service. Records were seen in relation to these activities. It was also noted that Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 20 meetings had been held with service users to gage their opinions about activities, including trips out of the home. Service users’ financial affairs in the main were handled by their families. Small sums of money were given over to the home to pay for purchases on behalf of service users such as toiletries, newspapers, hairdressing and similar. The records and balances for three service users were assessed and found to have been properly maintained. Safety arrangements seen at the inspection and information about the checking of safety systems provided before the inspection showed that health and safety issues were on the whole well managed. There was however a lapse in the fire safety arrangements as described in the summary of this report in relation to the open fire door to a rear staircase and the use of that area for smoking. Whilst the home needs to support those who wish to continue to smoke, this must be done so that there is no risk to anyone of the spread of fire. The door must remain closed and the fire officer consulted about these arrangements for service users to smoke in the home. Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 x 3 x x 2 Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered person must introduce a record that indicates medicine has been handed over to the service user for self administration. Service user’s wishes to vary the times for taking the medicine according to their symptoms must be taken into account on the risk assessment for self-medication. The registered person must ensure that fire doors that lead on to staircases are kept closed. The Fire Officer must be consulted about the practice of designating the lobby at the foot of the rear staircase as a smoking area for service users. Timescale for action 30/04/07 2. OP38 23(2)(4) 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chase House Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Ltd DS0000015034.V329389.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!