CARE HOMES FOR OLDER PEOPLE
Chaseley Care Home 404 North Promenade Blackpool FY1 2LB Lead Inspector
Mrs Jackie Riley Unannounced Inspection 09:30 30th May 2006 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 Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 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. Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Chaseley Care Home Address 404 North Promenade Blackpool FY1 2LB 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) 01253 352622 Encompass Care Ltd Care Home 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (23) Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to accommodate a maximum of 24 service users to include: up to 23 service users in the category of OP (older persons 65 ) 1 service user in the category MD (mental disorder, excluding learning disability or dementia). Date of last inspection Brief Description of the Service: The Chaseley Care Home is situated in a prominent sea front position in the North Shore area of Blackpool. It is close to transport links, which take you into the centre of Blackpool or to other areas of the Fylde coast. The home is also close to shops and other amenities. The Chaseley Care Home provides residential care for up to 24 older people. The home has four floors and there is a passenger lift to all floors. A chair lift is in place from the ground floor to the first floor. There are a number of aids and adaptations in place throughout the care home suitable for the age range and needs of residents living there. There are fifteen single rooms, nine with en-suite, and three double rooms all with en-suite facilities. There is a written Statement of Purpose outlining the home purpose and function, however this has not been reviewed, and there is no other information in the Service User Guide, which would inform people who use the service of what is available to them including information about how to make complaints. The most recent inspection report was not seen to be freely accessible to users of the service. At the time of the site visit (30.5.06) the information provided to the Commission showed that care home fees were £343 per week, any additional expenses including chiropody, newspapers and additional toiletries are met by the resident or third party. Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first of at least two unannounced site visits, scheduled from April 2006 to March 2007. This unannounced site visit took place during a daytime period over 6 hours, and was undertaken by two inspecting officers. The inspection included discussion with a number of residents, visiting professionals and visitors. In addition there were a number of comment cards received from users of the service prior to the site visit and the information will be used generally throughout the report to reflect on how the home delivers its care to users of the service. The site visit included observation of records, discussion with the manager and staff and included a tour of the home. Since the previous inspection there has been one complaint investigated by the Commission for Social Care and Inspection (CSCI). The complaint was thoroughly investigated and included liaison with healthcare professionals. It was conducted with full co operation of the homes management team. The outcome was partially upheld and action has been taken by the home to rectify the issues raised, so that there will be no reoccurrence. What the service does well:
The Chaseley Care home provides a warm and comfortable environment in which to live. Individual rooms are generally well decorated and furnished with individual personal items, so that residents feel comfortable with familiar items in their own rooms. The staff team are caring, and said they feel supported by the manager in dayto-day control of the home. The routines in the home were seen to be flexible with some residents choosing to stay in their rooms. The staffing numbers were seen to be good at the time of the site visit, in that there were enough staff to meet the range of needs of people living in the home. People spoken to said, “the meals are good and always hot”. Good nutrition is recognised as important by the home, which has a dedicated cook on the premises, who prepares fresh produce each day, so that people have a balanced and nutritional diet.
Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
There must be evidence the homes Statement Of Purpose and Service User Guide are reviewed and provide users of the service information about the home, its services and how they will be delivered, so that they are fully informed and know what to expect, what their rights are and how to complain. The home must endeavour to receive social work assessments prior to a resident being admitted if a social service assessment has been carried out, so that the home has a clear assessment of need to provide the level of care identified. All new staff must have access to essential training including Adult Protection and Medication, as well having a member of staff on each shift with a recognised First Aid qualification. There should be more effort made in ensuring there is storage space for unused wheelchairs and incontinence items so that there are no hazards for health and safety in the home. All staff recruited must have evidence of two written references on file. If this is not available or referees do not respond then two other referees must be found, so that there is evidence applicants are acceptable for the post applied for. In addition the homes application form must be extended so that there is evidence of the applicants previous employment history, as well as information applicable to the post applied for. Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 7 There must be more evidence of quality assurance systems in place so that there is evidence the home is monitoring how it operates and measures its stated aims and objectives, so that positive changes can be made if identified as necessary. Supervision records should be extended to include evidence the staff member has had supervision, which looks at staff performance as well as personal development and training needs. 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. Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 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 Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 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): 1 & 3, The quality outcome is poor. This judgement has been made using available evidence including a visit to the service. Residents are not provided with adequate information about the service on admission and their care has the potential to be jepordised due to lack of professional assessment information being given to the home at the time of admission. EVIDENCE: There is no evidence residents admitted to the home are provided with anything other than a brochure providing limited information. There is a requirement for all residents to receive a Service User Guide, which based upon Regulation 5 of The Care Homes Regulations 2001, which will give the resident or any third party a clear summary of the service they can expect, thereby making sure residents are fully informed and not disadvantaged in any way. Residents files which were looked at showed there is a revised assessment procedure in place, however there was evidence residents are being admitted without a professional social work assessment, which underpins the needs of that person. It was noted this information is frequently late and the management team endeavor to gain it prior to or at the time of admission to the home. There is evidence of the staff team now being involved in the
Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 10 assessment process by way of a key worker system. One member of staff said we have a good system in place now where staff are involved in the assessment process. Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The quality outcome is good. This judgement has been made using available evidence including a visit to the service. Residents healthcare needs are met by the systems in place. There must be ongoing training for all new staff responsible for drug administration so that people are protected. EVIDENCE: There has been much improvement in how the homes systems for recording healthcare needs, and recording essential information has improved for the benefit of residents living at the care home. Service user plans are much easier to follow showing a clear picture of how an individual needs are being met. There was evidence of residents going to optition appointments. A district nurse was visiting the service at the time of the site visit and commented positively on the staff teams ability to deliver good care to residents. A revised review system has recently been introduced, which shows monthly reviews are taking place and recorded on individual service user plans. A full six monthly review including imput from all areas including other professionals and family is being introduced, so that the residents needs are being met by changes being made at regular intervals when deemed as necessary. There is evidence staff responsible for drug administration have received training, however it is essential all new staff receive this training if they are to
Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 12 be responsible for the administration of medication, for the protection of residents and staff concerned. Areas of Privacy and Dignity are recognised by the staff team in that observations confirmed staff respect Privacy and Dignity when assisting with personal needs. Staff induction focuses on this area specifically so that all staff are aware of how to ensure individual Privacy and Dignity is upheld. Individual residents spoken to said, “Staff always knock on the door before coming in”. Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 13 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 The quality outcome is adequate. This judgement has been made using available evidence including a visit to the service. There are limited activities available in the home to meet the specific needs of an elderly resident group. Residents have choice in all aspects of their daily lives, however this is based upon individual risk. Good nutrition is seen as essential in meeting the dietary needs of residents. EVIDENCE: There has been no development in the homes activity programme since the previous site visit. This is an area which needs to be developed so that people living in the home have access to a range of activities specifically designed to meet the needs of an ageing group of residents, who have a range of levels of independence. Staff assist indivdiual residents to go out into the community and a few residents go out independently. One resident was going out at the time of the site visit and said, they enjoyed being able to come and go as they please. Indidivual residents enjoy staying in bed in the morning as seen during the site visit. Staff spoken to said this was not a problem, and staffing levels seen at the time of the site visit reflected this. There is a designated cook on the premises. Residents spoken to said they like the choice of food. Staff know the individual likes and dislikes and the cook is
Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 14 informed of this information so that there is a choice always available. Individual dietary needs are met, which is based upon nutritional guidelines. Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 15 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 The quality outcome is Adequate. This judgement has been made using available evidence indlcuding a visit to the service. Complaint information is not easily accessable thereby users of the service may be disadvantaged if they wish to complain. Residents are protected by staff receiving training in adult protection, however all new staff must receive training so that all users of the service are protected. EVIDENCE: Residents ability to make independent complaints may be jepodised due to access not being freely avialable in the homes Service User Guide, and that all complaint sheets are centrally held at the homes notice board, which may detract residents or others from accessing them. Residents are protected from abuse by ensuring staff have received training in adult protection, however training records show that whilst most staff have received this training, new staff have only had this area addressed by induction training, which does’nt clarify the member of staffs understanding of areas of adult protection and whistleblowing procedures. All staff must have training in this area so that all users of the service are protected. The homes policies and procedures in this area should be used as a training tool for staff, so that they are equipped with the knowledge to protect users of the service. Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 16 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 & 26 The quality outcome is good. This judgement has been made using available evidence including a visit to the service. The premises provide an environment in which residents feel comfortable. There have been improvements in areas of infection control for the protection of all users of the service, however there is a need to ensure all areas of the home are uncluttered for the health and safety of all users of the service. EVIDENCE: The homes environment is generally good in that the home is well decorated, a maintenance plan is in place with a designated maintenance employee, so that all general tasks can be undertaken when identified as needing attention. There is a requirement to ensure there are no offensive odours in the ground floor area so that the home is a pleasant environment in which to live and that all rooms are free from clutter, including the storage of wheechairs, and inconitnence pads. There had been infection control training so that staff have a knowledgable understanding of how to ensure there is no risk of infection by way of taking measures to control this including the introduction of bacterial soaps and paper towels in all rooms and bathrooms, and so protects residents.
Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 17 There has been additional hand washing facilities in the first floor bathroom and staff spoken to are aware of the need to ensure the cleanliness of these areas at all times. Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 18 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 The quality outcome is Adequate. This judgement has been made using available evidence including a visit to the service. Staffing ratios are based upon the dependency levels of residents occupying the home,at any one time. There is a staff training programme to meet the needs of residents, however all new staff must have access to essential training including medication management and Adult protection. Staff recruitment procedures protect residents however, information must be expanded upon so that there is evidence the applicant is equipped with the skills for the role applied for. EVIDENCE: Staffing levels are based upon the indivdiual needs of residents occupying the care home. There is evidence staffing levels are in place so that all residents are receiving the necessary level of care. Current levels are three care staff, one manager, one cook and one domestic and maintenance employee. This level of staff is variable at various time of the day. Night time cover is for one waking watch and one manager sleeping-watch. Equipment is in place to ensure all staff are able to meet the various levels of dependence. Staff recruitment procedures are in place, however there must be more information sought about the applicants skills and abilities in the application form, so that a balanced decision can be made for employment. In addition two written references must be available. In instances where this is proving difficult the applicant must provide additional referees. Fitness checks are in place prior to an employee starting employment at the home, so that residents are protected.
Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 The quality outcome is Adequate. This judgement has been made using available evidence including a visit to the service. The management systems are improving so that the homes operations are based upong good practice guidelines for the of users of the service. Health and Safety issues are addressed so that users of the service are protected. Quality Assurance systems need to be improved so that residents views are monitored and acted upon. EVIDENCE: There is an improvement in how the home operates with a full time manager in day to day control of the home. Revised recording systems have been successfully introduced, and staff spoken to said they like the new systems but it is taking time to adapt. The staff team also said they feel supported by the manager, who is available at all times using an open door policy. Supervision is being undertaken, but records are poor in that they provide little structured information as to the development of indivdiual staff members. There is also a
Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 20 need to ensure supervision is taking place formally between the manager and registered provider so that there is evidence of the management team working in unison to make sure quality assurance systems are in place and being measured so that the home is meeting its stated aims and objectives. One relative spoke positively about the manager in day to day management of the home, and they felt confident in how the home is operating. Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 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 1 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 3 Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 22 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 registered provider must include evidence of a review of the homes Statement of Purpose and Service User Guide The registered provider must provide a Service User Guide and make this available to all users of the service. The registered provider must provide a copy of the homes complaints procedures to all users of the service. The registered provider must ensure all staff receives training in Adult Protection, medication (if responsible), and first aid. The registered provider must ensure there are two written references for all staff being employed by the home. There is a requirement for there to be a manager registered with Commission for Social Care and Inspection (CSCI), in day-to-day control of the care home. (Previous timescale of 31/03/06 not met) Timescale for action 31/07/06 2 OP1 5 31/07/06 3 OP16 22 31/07/06 4 OP30 18 30/09/06 5 OP29 19 31/07/06 6 OP31 8 31/07/06 Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 23 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 2 3 Refer to Standard OP33 OP29 OP36 Good Practice Recommendations There should be more development in how the home monitors its delivery of care through quality assurance systems. The homes staff application form should be extended to provide more information about the applicant’s skills, qualifications and experience. The current staff supervision record should be revised to include more evidence of what was discussed, with agreed outcomes to reflect personal development. Chaseley Care Home DS0000066020.V285699.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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