CARE HOMES FOR OLDER PEOPLE
Chaseborough House Village Hall Lane Wimborne Dorset BH21 6SG Lead Inspector
Trevor Julian Key Unannounced Inspection 20th July 2006 11:00 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 Chaseborough House DS0000026779.V305341.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. Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Chaseborough House Address Village Hall Lane Wimborne Dorset BH21 6SG 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) 01202 822908 Mrs Sally Ann Marshall Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th March 2006 Brief Description of the Service: Chaseborough House is a care home accommodating a maximum of 16 older people. The premises are situated in a rural setting between Verwood and West Moors at Three Legged Cross, with local amenities including a pub, shops and village hall available within a short level walk. Accommodation is offered on the ground and first floor. The communal lounge and dining room are on the ground floor. A passenger lift operates to the first floor. There are twelve single rooms and two rooms registered doubles. All but one room has en-suite facilities, including seven rooms with baths, WC, and hand basins. The premises consist of a large converted family house set in its own grounds. The owners live in the adjacent property. The current fees ranged between £400 – £450 per week. Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Thursday 20th July 2006 between 11:00 and 16:00. The purpose of the visit was to monitor compliance with legislation and to check progress with requirements and recommendations made previously. A pharmacy inspection was completed on 24th May 2006 and a letter detailing the findings sent to the home; a copy of that letter is available on request. Before the visit nine comment cards were received from residents, nine visitors, a care manager and three GPs; giving their view of life at Chaseborough. During the visit information was gathered through discussion with residents, visitors, staff and the owner. Further information was obtained from examination of records and a tour of the premises. What the service does well:
The comment cards once again showed that the residents and those involved with the home have high regard for the services provided. The home was described as a “happy place”, “a home like environment” etc. One GP wrote, “an excellent care home”. The home carries out pre-admission assessments to ensure they are able to meet the needs of the individual. One person, recently placed at the home, said his family had found the home for him and although he had not visited before admission he had been pleased with the accommodation and care that he received. Records showed that GP’s and the community nursing team were called as needed this was also confirmed by the residents and visitors. Residents and visitors said the staff treated people with dignity and respect. The staff knocked bedroom doors before entering and there were appropriate door locks allowing residents privacy. The home arranged regular entertainment in the home. Residents spiritual needs were considered on admission and arrangements made with local churches to meet any religious needs. The home also arranged in house services. People said they appreciated their trips out with Mrs Marshall and they were satisfied with the activities arranged to keep them occupied. They found the home offered good levels of choice, they were able to choose their preferred time for getting up and going to bed where to take their meals. There was a choice of food offered for each meal and a record kept of the chosen items.
Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 6 Residents and visitors said that they had not needed to make a formal complaint but all said they were able to discuss any problems with Mrs Marshall or her staff. The home provides a comfortable clean and hygienic environment with easy access to all parts. Staffing levels were appropriate to the needs of the residents. Training was in place to ensure that the staff had appropriate skill and knowledge. Mrs Marshall continues to work towards achieving her Registered Managers award to help manage the home professionally. All those spoken to were very happy with ethos and care provided in the home. The home did not assist any of the residents with financial management but most people deposited personal allowances with Mrs Marshall to cover personal expenses e.g. hairdressing, chiropody etc. What has improved since the last inspection? What they could do better:
Care plans had been reviewed however, risk assessments for individuals need to be developed. On one file, there was no information on equipment provided as a precaution against pressure ulceration. The care plans did not show the involvement of the resident or their representative. There was no evidence of nutritional assessments or weight checks. Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 7 The home was working to implement improvements suggested by a recent pharmacy inspection. During the tour of the building it was noted that most radiators had been covered however in one room on the ground floor there were two radiators, one covered the other not. The bed was placed directly against the unguarded radiator and as such was a hazard. Mrs Marshall agreed to take action to address the problem before the heating was needed. She should also carry out a complete audit of the hoe to ensure no other radiators present a risk. The homes quality assurance procedure needs to be developed to ensure that the views of those using the service are included in the homes development plan. 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. Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s assessment process ensures that they are able to meet the needs of the individual. EVIDENCE: The home had admitted one person since the last inspection. The records confirmed that the owner had carried out a pre-admission assessment before being offered a placement at Chaseborough. The assessment covered the required topics including basic information about falls history. Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans did not contain sufficient detail to inform staff how needs were to be met. The home maintains good links with the local healthcare services to help ensure that any health needs are met. The staff treated the residents with dignity and respect in order to protect the residents’ rights. EVIDENCE: The files of three residents were checked. One person’s file held conflicting information about their mobility; it did not show the resident’s involvement in the care planning process and there was no risk assessment. Another file did not include details of pressure relieving equipment supplied as a precaution as there was a risk of pressure ulceration. The care plans must be developed to include any specialist used, risk assessments and show regular reviews. The
Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 11 care plans should be drawn up with the involvement of the resident or their representative. Each person should have a nutritional assessment to include weight checks. Details of a suitable assessment tool were provided following the visit. The daily records held sufficient information on how needs were being met. There was evidence of GP involvement as needed, the records also showed the social needs being met. Following a recent visit by the Commission’s pharmacy inspector the home had take action to address most of the issues identified. The outstanding issues are covered by requirements and recommendations referred to at the end of this report. During discussion with the residents, they confirmed that the staff call for GP or Community Nursing visits as needed. People said they were treated extremely well by the staff and that their privacy and dignity was respected. All bedrooms were fitted with appropriate locks allowing the residents to lock their doors but the staff had passkeys in case of emergency. Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents in the home are encouraged to remain as independent as their circumstances allow. Family and friends are made welcome to participate in the life of the home. The home encourages connections with the local community. The residents enjoy the choice and variety of food offered. EVIDENCE: The home arranges entertainment within the home for the residents. Several commented that they enjoyed the monthly piano concerts. The home is situated in a quiet rural setting and several of the residents enjoy pottering in the garden or wandering in the lane leading to the home. There are shops and other amenities close by and are accessible to one of the residents. A member of staff collects a daily order of newspapers for those residents who have requested a paper. The home makes contact with local churches to arrange trips to church for those with spiritual needs. The home also holds monthly interdenominational services in house for those who cannot get to church.
Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 13 The home welcomes visitors at all times, several visitors came and went during the visit. They said they were always made welcome; one person was a regular visitor and often enjoyed Sunday lunch in the home with his friend. Residents also said they were able to exercise good levels of choice in their daily lives, there were very few rules in the home and people were able to choose their time for getting up and going to bed. One person added that there were no set bath times and they could request one at any time. Comment cards from the residents showed that they felt there was normally enough to going on in the home to keep them occupied. Residents said they enjoyed the range and choice of food offered in the home and always looked forward to the meals. Alternatives were offered if the choices offered did not suit the individual. Several people said that often Mrs Marshall took residents for trips out in her car. Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. For the protection of the residents, the home had systems in place for responding to complaints and allegations of abuse. EVIDENCE: The home provides information to residents and visitors about the home’s complaint procedure. None of the residents or visitors seen had needed to make a formal complaint as any concerns are addressed immediately be Mrs Marshall and her staff. Staff have access to “No Secrets” a document giving information on local adult protection procedures. Staff spoken to were aware of their responsibilities when responding to signs or allegations of abuse. The home had developed a new policy on adult protection which was signed and dated, further guidance was provided to ensure all the required topics were included. Chaseborough House DS0000026779.V305341.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home offers a good standard of accommodation with good accessibility for residents and visitors. Some of the home’s heating radiators continue to pose a risk of burns to the residents. The home was clean and well presented providing the residents with a safe and comfortable environment. EVIDENCE: The home has a passenger lift to the first floor; a new ramp was being built to allow easy wheel chair access to the home. Mrs Marshall was waiting for a new boiler to be installed. Most of the radiators in the home had been covered in order to protect the residents from burns. However it was noted in one
Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 16 bedroom that one radiator was covered but another right by the bed was not and could result in the resident getting wedged between the bed and the hot surface. The matter was pointed out to Mrs Marshall who agreed that the radiator would be covered before the heating was needed. It is essential that an audit of the home is completed to ensure that radiators have been covered or the risk has been effectively assessed. The home was clean and well aired. All the rooms seen were comfortable and had been personalised by the occupant. There was also evidence of protective gloves and aprons to manage the risk of cross infection. In the comment cards residents expressed very good levels of satisfaction with the standard of cleanliness. Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is appropriately staffed by a competent staff team. The home’s recruitment policy and staff retention helps to maintain a safe place for the residents. EVIDENCE: The home was well staffed at the time of the inspection. The home benefits from having a stable and loyal staff with little turnover. Since the last inspection only one person had been employed, Mrs Marshall knew the new member of staff for several years before appointment all the required clearances were in place at the time of the visit. Staff files showed that staff receive training in core and specialist topics. Several of the staff have achieved NVQ level 2 in care. The residents described the carers as very kind and caring. They reported that when the call bells were used the staff responded promptly. Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Chaseborough is a well managed home operated for the benefit of the residents. The quality assurance system is in place but needs to be developed to ensure that the views of the residents and others are fully considered. Residents are protected from financial abuse while in the home. The home offers the staff and residents a generally safe environment although areas could be improved. Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 19 EVIDENCE: Mrs Marshall has run the home for several years and continues with her Registered Managers Award NVQ level 4. Comment cards describe the home as providing a warm and caring environment. The home provides good levels of care however, there are shortfalls in the administration and management systems. The home had recently completed another quality assurance survey and was waiting for the results. This then needs to be developed into a business development plan based on the outcome of the survey. The home did not manage the finances for any of the residents however most residents deposited personal spending cash with the home for hairdressing, chiropody etc. A small sample showed that the cash held matched the transaction records. The training records showed that the staff received training health and safety including fire safety procedures and food hygiene. Equipment provided for safe moving and handling was seen to be regularly services by approved contractors. Generally health and safety was managed to a reasonable standard however, there remained concern that as yet the risk of burns from hot surfaces had not fully been addressed. Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 20 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Where pipe work and radiators are not guarded or have guaranteed low temperature surfaces, serious risks must be identified and as far as possible eliminated. This assessment must be pertinent to the individual(s) assessed and be written down. Previous time scale for action 6 March 2005. Pre employment checks as required by law must be undertaken prior to any staff working at the home. e.g. CRBs / POVA 1st checks. Records required by law in respect of staff employed must be held in the home. e.g. proof of ID. Previous time scale for action 31/1/06 Effective quality assurance and quality monitoring systems, based on seeking the views of service users, must be in place to measure success in meeting the aims, objectives and
DS0000026779.V305341.R01.S.doc Timescale for action 1. OP25 13 30/09/06 2. OP29 17 31/10/06 3. OP33 24 31/10/06 Chaseborough House Version 5.2 Page 22 statement of purpose of the home. This requirement was first made 10th July 2002 and is repeated for the sixth time. There must be a clear audit trail that accounts for all medication and evidence of regular monitoring of this and the medicine records to ensure that medicines are given as prescribed and accurately recorded. 4. OP9 13(2) 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Every care plan should include a risk assessment. The care plan and risk assessment should pay particular attention to the prevention of falls. The care plan should be reviewed at least once a month and updated where appropriate. How the resident or their supporter was involved in drawing up the care plan should be noted and the plan signed to show agreement where possible. The home should follow guidance from the Royal Pharmaceutical Society including: Handwritten details of prescribed medicines on the medicine chart should be checked and signed by a second competent person to confirm that all the details are correct. There should be a list of staff authorised to give medication and their specimen initials and they should be evidence that they have been assessed as competent to do this. There should be a record of any allergies or problems with medicines on or with the MAR chart to inform staff. 2. OP7 3. OP9 Chaseborough House DS0000026779.V305341.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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