Inspection on 29/10/07 for Chasedale

This inspection was carried out on 29th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chasedale 10/02/10

Chasedale 21/01/10

Chasedale 27/10/09

Chasedale 28/01/09

Chasedale 22/04/08

Chasedale 02/11/06

Chasedale 02/02/06

Chasedale 20/06/05

Chasedale 06/01/05

Chasedale 11/08/04

Chasedale 09/02/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Chasedale Tynedale Drive Cowpen Estate Blyth Northumberland NE24 4LH Lead Inspector Suzanne McKean Key Unannounced Inspection 29th October 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chasedale DS0000000508.V353680.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. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chasedale Address Tynedale Drive Cowpen Estate Blyth Northumberland NE24 4LH 01670 - 365997 01670 365732 chasedale@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd 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 Susan Ann Gibbon Care Home 60 Category(ies) of Dementia (50), Old age, not falling within any registration, with number other category (10) of places Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 10 2. Dementia - Code DE, maximum number of places: 50 The maximum number of service users who may be accommodated is 60. 2nd November 2006 Date of last inspection Brief Description of the Service: Chasedale Nursing Home is a two storey, purpose built facility of traditional brick build and tiled construction. It is situated on the edge of a large residential estate approximately two miles from the centre of the town of Blyth. The home is well served by public transport. The home has a car park to the front from which there is level access to the main entrance. There are grassed sitting areas, which are accessible to, and for the use of, residents and visitors. The home is registered to provide care to 60 persons 10 of which are the category of old age requiring nursing care and the remaining 46 under the category of dementia care (nursing). The home charges fees of between £380.42 and £400.78 per week depending upon the needs and requirements of the individual residents. As the home provides nursing care the free nursing care element of the funding is provided in addition to the costs charged to the resident. The home provides information about the service through the service user guide. A copy of the last inspection report from The Commission for Social Care Inspection is available in the entrance to the home. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • Information we have received since the last visit on 2006. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 29th October and further visits were made on 31st October and 1st and 5th November 2007. During the visit we: • Talked with people who use the service, relatives, staff, the manager & visitors. • Looked at information about the people who use the service & how well their needs are met, • Looked at other records which must be kept, • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, • Looked around the building/parts of the building to make sure it was clean, safe & comfortable. • Took advice from specialist advisors from Environmental Health and Communicable Disease Nurse. We told the acting manager what we found. What the service does well: What has improved since the last inspection? The home has not made any improvements since the last inspection. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 6 What they could do better: The home must have an effective manager to improve the standards and to make sure that there is effective leadership in the day to day management of the home. This will also improve the standard of the care being given and support residents to have a good quality of life taking into account their views and choices. The staff must be supported so that they can feel confident that they will be able to meet the needs of the residents in a professional and effective way taking into account good practice principles. Specific improvements are necessary including: • Bringing up to date the service user guide and the statement of purpose • Improving the quality of the care planning and keeping records in line with the Company’s policies and procedures. • Make sure that the health and welfare of the residents is centred around the person. • Review how the way medication is managed and improving the records kept. • Make sure that residents can get involved with a variety of social activities, and keep a record of what this is. • The way residents are supported to make choices in their day-to-day lives and recording it in detail. • The food and fluids being served to the residents including giving real choices and making the experience a rewarding one for them. • Making sure the catering staff receive the training to give them the skills to do their job. • Look at how complaints are handled and review the way they are recorded. Make sure that the outcome and action taken is clearly recorded. • For senior staff to follow adult protection procedures so that residents are protected. • Undertaking a programme of redecoration, re-carpeting and replacement of furniture in the bedrooms, communal areas and bathrooms, so that resident live in a pleasant and safe environment. • Complying with the advice given by the Health Protection Unit in relation to control of infection. • Review staffing levels and recruiting and employing staff and then providing training for them so that staff working in the home have the skills to do their job. • Have enough numbers of trained mental health nurses to overview and direct the care being given to residents. • To train staff to move and transfer residents safely and have enough of the right equipment to do this. • Having a system that reviews the quality of the care. • Making sure that staff follow the Company’s health and safety policies. This should include detailed risk assessments where they are needed. Chasedale DS0000000508.V353680.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. Chasedale DS0000000508.V353680.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 Chasedale DS0000000508.V353680.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although good assessments of need are made before moving into the home, residents are not given enough information to help them make an informed choice about moving in. EVIDENCE: The home has a statement of purpose and service user guide, which combines the company’s pre-printed brochures and the information which relates specifically to the home and the service they provide. This is not in sufficient detail to describe the service the home provides particularly within the different units. The care plans all have pre-admission assessments, these had been carried out by either the manager or by a senior member of the staff team. There have been recent situations when residents have needed to be moved from one unit Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 10 to another resulting in some problems with individual residents care. It is not clear how this has happened for example if they were not placed in the appropriate unit or if the combination of resident needs created the environment in which the issues arose. The residents also have a care management assessment, which is provided to the home on admission. An individual care plan is produced from these documents. The home is not registered for, and therefore does not provide, intermediate care. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Lack of leadership prevents care from being well planned and delivered and people are not treated with respect. This means that residents needs are not met in a consistent way and may leave them at risk of harm. EVIDENCE: All residents have a care plan which includes an assessment of their needs and a plan of how these should be met. These were not completed in sufficient detail and the reviews were not up to date. The Four Seasons documentation includes risk assessments for prevention of falls, wound care, and moving and assisting as well are assessment tools for clinical areas such as continence promotion. These had been completed to a varying standard and did not reflect the health or social care needs of the residents in sufficient detail. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 12 There is an assessment to look at residents’ food and fluid intake. These did not clearly show if a fluid balance record is required. The record of fluid intake was poorly managed and did not show that fluid intakes were being totalled to allow nursing staff to gauge if adequate amounts of fluids were being taken to maintain their health. People living in the home were not given enough to drink. Some residents who were in their rooms being cared for on recliner chairs had no access to drinks or their buzzer. An immediate requirement notice was issued at the end of the first visit to ensure that residents would be given adequate amounts of fluid and that this would be recorded. At the second visit it had been generally improved however one resident had not had their fluids recorded for six hours and another had their fluid intake recorded for 1600 and 1800 when these had not been given, as it was three thirty in the afternoon. This was reported to the manager and appropriate action taken. Stadd were not confident when transferring residents, they had not received training, a hoist was broken and they were unaware of aids that could assist them. This resulted in some residents being left in chairs in the lounge when they needed to be moved for personal care or meals. The necessary moving and handling equipment was found when requested but it was not readily accessible to the staff and was not being used. During the first visit the manager who was assisting with the inspection arranged for a trainer (from another home in the company) to come to the home that day and give the necessary instruction to the staff. Additional sessions were organised for the other staff. She also found the equipment that was in the home and made sure that the staff could access it and use it. An immediate requirement notice was issued at the end of the first visit to ensure that the moving and handling practices were improved and that the staff were trained and the equipment made available. Residents access NHS services and facilities as necessary. The care plans showed that specialist advisors are used for individual residents. The home liaises with the General Practitioners who provide care to the residents. The care was being given by staff who were pleasant and courteous and number of residents were enjoying the staffs company. The care plans show that the personal and health care needs of some of the residents are being met. However the care being delivered to some of the more poorly residents was not adequate, residents who were being cared for in their rooms were left for long periods without any stimulation or personal contact. No drinks were available for them, which although they were unable to take themselves, were not available for staff to provide throughout the day. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 13 The company’s medication policy is comprehensive and clear. Some of the home’s local information for staff is ambiguous and needs updating so that staff always understand what is expected of them. Staff do not always follow best practice guidance when giving medicines to people living in the home. This means people living in the home are not always protected from medication errors or the risk of infection. Most medicine records are up to date and contain no significant gaps. All hand written entries should be checked to reduce the risks of mistakes when copying complex information. Most medicines in the home are stored safely. However, improvements in the storage and checking of controlled drugs need to be made to ensure no diversion or loss occurs. Generally the staff were friendly toward the residents and were attempting to engage them in conversation. However some comments were made regarding the intimate needs of the residents in the public areas in the hearing of the others. The personal care needs of residents were displayed within bedrooms and outside of the lounges. One example of this related to residents being taken to the toilet and identified residents and was “ticked” when they had been, it was on the corridor next to the lounge on the first floor, and was removed immediately. These practices suggest that the culture of the home does not protect the individual residents dignity or privacy. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are limited, and mealtimes are poorly organised. This prevents people from leading full and active lives. EVIDENCE: The staff described how they try give residents ways of taking control of their daily routines, in simple but important ways for example the time they get up, what and when they eat and how they spend their time. Staff confirmed that they assist residents to make choices about how they spend their day, however the lack of leadership and reduced staffing numbers results in poor choices and the care being task led. The home employs an activities co-ordinator (she is currently not working in the home) who has a weekly programme of activities offering differing opportunities. This is not sufficiently developed to offer individualised activities for the residents in line with their social assessment. The dependency level of Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 15 some of the residents means the activities on offer need to be less active and provided on a more one to one basis. The records of the activities provided are not detailed, and need to be developed further to show the full extent of the things going on in the home. Residents have visitors at any time and are able to use their own rooms, the small lounges or the larger, busier lounges to receive them. Relatives are given information within the residents’ guide about visiting arrangements. Residents said they were satisfied with the arrangements for visitors and that staff welcome them. During the visit the main meal was observed it was not well organised and was not a good experience for residents. Many of the residents had to wait for assistance and there were not sufficient staff to provide the support needed. Residents remained within their rooms or lounges, tables were not appropriately set, no one was aware of what was being served and the food was not sufficiently hot nor well presented. There appeared to be insufficient dining space and again limited leadership or organisation. Several residents said the enjoyed the food in the home and cleared their plates. An example of resident’s comments was one who said, “this is lovely” and “ the food is always nice”. The environment health inspection identified the need for training to be given to the catering staff so that they can provide good quality food safely. The report of the visit was given to the acting manager so that she could take the necessary action. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 16 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): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complaints and safeguarding issues are not well managed and may leave people at risk of harm. EVIDENCE: The company’s complaints procedure is available in the service users guide and a copy is available at the front entrance and is displayed in the home. The records of the complaints were examined. There is some evidence that concerns were being raised by relatives and staff, which were not considered through the complaints process. Three relatives who were visiting the home were aware of the complaints procedure and had raised concerns with the manager. Staff were not given opportunities to express their concerns with the manager, although the regional manager did take steps to find out their views. Staff are given protection of vulnerable adults training both as part of the inhouse training package and from outside organisations. The home has written guidance in place regarding the protection of vulnerable adults through detailed policies and procedures. These are included in the induction training and ongoing in-house training. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 17 Staff confirmed that they knew about the guidance and could identify the action they would take if they were made aware of or had any concerns regarding this issue. It was noted that care staff had followed procedures and reported concerns to nursing staff; these were not acted upon meaning residents were at potential risk. An immediate requirement notice was issued to ensure that all senior staff understood and would implement adult protection procedures as necessary. There have been three safeguarding adults investigations carried out involving the home. The manager worked within the process and some remedial action was taken in response to the issues raised. However in a specific case previously agreed levels of supervision of a resident had been agreed but had not taken place. The records were not completed in sufficient detail to demonstrate that the resident was being supervised in a way, which would safeguard the other residents in the home. The regional manager has already taken appropriate action to address the some of the issues that have been identified in this process and she will be looking again at the issues raised when completing the improvement plan for the home. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 18 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): 19 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The building is dirty, unhygienic and in a poor state of repair. This doesn’t create a safe or comfortable enivronment for people to live in. EVIDENCE: There are significant problem with the hygiene standards, the maintenance and décor of the home. Detailed information was provided to the home so that they could take action as necessary. The following problems were found:Bedrooms • Doors were wedged open • Wardrobes were not secured to the wall and large items were being stored on them. • Toilets were dirty and stained. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 19 Call buzzers were not accessible. Stained mattresses (to protect residents from injury if falling from their beds) were being stored in the en-suite preventing access to toilet. • A number of bathroom and en-suite had no liquid soap. • Damaged walls, some having been filled but not decorated. • Intertumescent fire strips to some doors were loose. • Some carpets (identified to staff) were damaged presenting a trip risk • Armchairs were very dirty. • Windows were damaged and/or had gaps one of which was packed with paper. • Beds and walls stained with faeces. Sluices • Two out of the three sluice disinfectors were not working and had not been for at least 5 months. • No double bagging of incontinence pads happening to reduce odour. • Very untidy and no access to handwashing facilities Bathroom and toilets • Damaged hoist seats. • A non-slip mat was very dirty. • Toilet brushes being stored in dirty water. • En-suite lights not working • Offensive odours throughout the home. • No blinds/curtains Dining Rooms • Floors very dirty, old food and stains. • Tables and chairs encrusted and dirty. • Windows dirty and or damaged. Lounges • Dirty armchairs. • Large TV in one lounge broken for at least one month. Corridors • Damaged walls. • Pictures removed. Laundry • Soiled and dirty clothes/laundry on the floor unbagged. • Offensive odours. Faeces in sink. Unlocked with cleaning materials accessible. • Hand washing liquid soap but no paper towels, very untidy. Nurses Station • Care plans not kept securely General issues • Throughout the home décor/wallpaper damaged. • Some bedrooms had a bolt on the outside of door, some were broken. • Personal care notices displayed in clear view of anyone in the home. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 20 • • • • • • • Call system cords were not to floor or red Extractor fans not working. Linen cupboard not lockable, untidy. Insufficient linen, sheets/pillowcases faded and worn. Towels shabby. Wheelchairs were generally dirty. An immediate requirement notice was issued at the end of the first visit to ensure that the building issues related to health and safety would be identified and action taken as a matter of urgency. The standards of hygiene in the home were very poor. All areas were dirty and there was an offensive smell of urine in a number of areas including the main lounges and bedrooms. The bathroom areas as well as being dirty would not have been pleasant places to experience what should be a positive experience for the residents to enjoy. This is not an exhaustive list of the work that is needed but it is an overview of the type of issues that were found. A more detailed list was given to the home so that action could be taken. A referral was made to the Northumberland Tyne & Wear Health Protection Unit and a representative visited the home and undertook a very detailed inspection and the outcome of this visit was reported back to the acting manager. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels and systems around recruitment, selection and training of staff are inadequate to meet the range of needs of the people using the service. The home has insufficient number of staff employed. EVIDENCE: Staff recruitment and selection records were complete including two references and a completed application form. The requirement to have a CRB and POVA check in place is applied to all of the staff in the home. However there have been problems with the type of staff recruited. There are only two Registered mental nurses on the staff team. It is appropriate for the staff team to have different skills. However, the complexity of the residents needs, especially in the all male unit, means there is an increased need for a highly skilled staff team. This way the care can be planned and frequently reviewed. This should reduce the risk of untoward incidents occurring and make sure the residents have their mental health needs met. The staffing rota’s showed that there were periods when there was not enough staff scheduled to work. Staff sickness and holidays results in periods when Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 22 there are insufficient numbers of staff on duty to meet the needs of the residents. Care staff were working additional hours to those they were contracted for and were being asked to cover at short notice and when they had already worked a number of days. Relatives said that they were concerned that there are not enough staff on duty and that there were times when the nurse call buzzers were not being answered within a reasonable time scale. The staff are not all fully up to date with moving and handling (see health and personal care section of report re Immediate requirement issued) first aid, and fire training. They are offered a number of other training opportunities including pressure area care; continence training and catheter care training, however staffing shortages have prevented staff from attending the ones they were interested in or needed to do. The staff are encouraged to undertake National Vocational Qualifications (NVQ 2) once they have had their induction training. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management of the home has lacked consistency and leadership. This has placed people at risk of harm. EVIDENCE: There was poor leadership in the home both in the way the care was being delivered to the residents and in the way the home was being organised. This included the organising of training, staffing and supervision and ensuring that the home was being maintained and equipped adequately. There was very poor leadership on a day to day basis this resulted in staff focusing on tasks rather than looking at the overall needs of the residents. The Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 24 staff worked hard however they were not being well supported. Tasks such as making the beds were being prioritised over resident welfare issues such as making sure they had enough fluids. Relatives were complementary about the staff but were concerned as they felt that there were not enough of them and that they were always too busy to spend time with the residents. A relative said that sometimes call buzzers were not being responded too in a reasonable time. Discussion with the relatives suggested that they related better to the carers than the qualified staff. Although it is positive that they felt that they could talk to the carers it suggested poor communication with the senior staff and is at risk of compromising the way information is shared. Personally allowances are well managed and audited, however these have revealed some discrepancy, which is currently being investigated. The residents and relatives have been informed. The staff, residents and relatives were not confident that their views were listened to and valued by the Manager. Although the regional manager was attempting to elicit these views this was being compromised by the way the home was being managed. The annual quality assurance assessment (self assessment) was returned to Commission for Social Care Inspection and this did not reflect the poor standard of the service being provided. At the beginning of the inspection the Registered manager was not working in the home. Two managers from other homes in the same company were working in the home and assisted in the inspection process. By the time the inspection visits were complete a manager from a dementia care home who is a Registered Mental Health nurse was put in to the home to act as the manager. Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 X X 1 Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 26 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. 1. Standard OP1 Regulation 6 Requirement The service user guide and the statement of purpose must be improved to show the way the service is being provided. Each resident must have an up to date care plan containing sufficient information for the staff on the care to be provided. The home must promote and make proper provision for the health and welfare of the residents. The registered person must ensure that: • medication is always administered according to current best practice guidelines so that people are protected from medication errors; • handwritten entries on medication charts are always signed, dated and witnessed to reduce the risk of mistakes when copying complex DS0000000508.V353680.R01.S.doc Timescale for action 01/03/08 2. OP7 15 01/12/08 3. OP8 12 01/11/07 4. OP9 13 01/12/08 Chasedale Version 5.2 Page 27 • information; all controlled drugs are always stored according to current relevant regulations and that regular checks are made to ensure no loss or diversion takes place. 01/12/08 5. OP12 16 The residents must have more opportunities to be involved in varied and individualised social activities, which must be recorded in detail. Outstanding from 01/12/06 Residents must be supported to make choices in their day-to-day lives and this must be documented in detail. All residents must receive an adequate diet according to their choices and needs. 6. OP14 14 01/12/08 7. OP15 16 01/11/07 8. OP15 16 The catering staff must be 01/02/08 provided with training to give her the skills and competencies to fully fulfil her role. Outstanding from 01/03/07 The way complaints are managed in the home must be reviewed to ensure that they are managed effectively. Staff who are acting in charge of the home must understand and implement the safeguarding procedures. Agreed safeguarding strategies must be followed to ensure that the safety of the residents is maintained. The home must undertake a programme of redecoration, reDS0000000508.V353680.R01.S.doc 9. OP16 22 01/12/07 10. OP18 16 01/11/07 11. OP18 12 01/11/07 12. Chasedale OP19 16 01/07/08 Page 28 Version 5.2 carpeting and re-placement of furniture in the communal areas and bathrooms. 13. OP19 16 The home must undertake a programme of redecoration, recarpeting and replacement of furniture in the bedrooms. The home must comply with the advice given by the Health Protection Unit in relation to control of infection. Staffing levels must be reviewed to ensure that sufficient staff are provided to meet the needs of the residents. Outstanding since 01/12/06 The home must employ staff who have the skills and experience to ensure they can meet the needs of the residents. The home must provide training to ensure that the staff working in the home have the skills and experience necessary for the work they do. The home must submit an application to register a manager with Commission for Social Care Inspection. The provider must maintain a system for evaluating the quality of care in the home. The home must take action to ensure they are acting in the best interest of the residents when managing personal allowances on their behalf. The registered individual must ensure that the staff follow the DS0000000508.V353680.R01.S.doc 01/07/08 14. OP26 13 01/12/07 15. OP27 18 01/11/07 16. OP29 19 01/01/08 17. OP30 19 01/01/08 18. OP31 8 01/01/08 19. OP33 24 01/01/08 20. OP35 20 20/11/07 21. Chasedale OP38 13 01/01/08 Page 29 Version 5.2 company’s health and safety policies including the completion detailed risk assessments as necessary. 22. OP38 13 A fire risk assessment must be completed and available. Outstanding since 01/12/06 01/12/07 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 Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern No1, Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 Chasedale DS0000000508.V353680.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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