CARE HOMES FOR OLDER PEOPLE
Chaseview Care Centre Off Dagenham Road Rush Green (hospital Site) Romford Essex RM7 0XY Lead Inspector
Ms Edi O`Farrell Unannounced Inspection 14 November 2005 10:55 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 Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 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. Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Chaseview Care Centre Address Off Dagenham Road Rush Green (hospital Site) Romford Essex RM7 0XY 020 8517 1436 020 8595 8960 wonge@bupa.com 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) BUPA Care Homes (CFH Care) Limited No. 2741070 Mrs Evet Elizabeth Wong Care Home 120 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (90) of places Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th May 2005 Brief Description of the Service: Chaseview Care Centre is a registered care home with nursing operated by BUPA, a large, private sector, provider with many similar homes across the UK. It is situated in a residential part of Romford, on a main bus route to both Dagenham and Romford town centres and rail/tube links. There are 120 places in total, spread across four houses, each of which provide 30 places. Ford House offers specialist nursing and personal care for older people with dementia; Kennedy House and Nicholas House each provide nursing and personal care for older people who have physical and psychological disabilities/illnesses; and Hart House provides residential care for older people whose nursing needs can be met by visiting professionals. Each house has a similar layout of 30 single, ensuite, bedrooms, communal bathrooms, shower rooms, and toilets, large lounge/dinning area, small kitchen, staff office, sluice room, and clinic room. All areas are fully accessible to wheelchair users, and have aids to assist people with physical disabilities. The accommodation is spread over two floors, and there are lifts in each house. A central kitchen and laundry service all four houses. Two of the houses have sensory gardens, and a volunteer runs a gardening club. Four staff are employed specifically to organise activities, and the nursing and care staff are supported by a team of catering, domestic, administrative, and maintenance staff. Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This, unannounced, inspection took place on a weekday from approximately 11.00am to 4.30 pm. The focus was on checking progress in relation to eleven Requirements set at the previous inspection, and on assessing four core Standards not assessed then. This was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits, all core Standards have now been assessed. Eleven Requirements were set at the previous inspection and the Registered Manager has complied with all of the required action. During this visit there was a specific emphasis on staff recruitment, training, and supervision and the overall management of the home. These were important aspects to check at this visit as the last one had mainly concentrated on checking the quality of direct care to service users. There was therefore less direct contact with service users on this visit, and more discussions with staff and management. Each of the houses was toured, and records, such as care plans and medication administration charts, were checked. Some aspects of care were discussed with staff, and with the Registered Manager. What the service does well:
Although this is a large home with a total of 120 beds the design of the building, with the four separate houses, means that living there is like living in a smaller home. Each house has a separate team of nurses and carers, and this means that they and the service users can get to know each other well. This is particularly important where service users have limited verbal communication. As one of the houses is residential, and the other three are nursing this should mean that residents of the former would not have to move from the home if their needs increase, therefore reducing the level of disruption to their lives. The houses are bright and airy, and well decorated and maintained. All bedrooms have an ensuite toilet, and service users are encouraged to personalise their rooms. This includes small items of furniture and personal bedding, where wished. There is ample internal communal space, and some pleasant outdoor seating areas. There is a varied activity programme, which service users, and their friends and relatives, are encouraged to take part in. The home has a good assessment and care planning system, which means that service users’ needs can be identified and met. Specialist visiting
Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 6 professionals, such as the tissue viability nurse, provide additional advice when necessary. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standards 1, 4 and 5 were not tested on this visit. However evidence from the last inspection was that service users have the information they need to make an informed choice about where to live. Prospective service users, and their relatives and friends, have an opportunity to visit the home, and to speak to other service users and staff. Information gathered during the pre-admission assessment is now being used to develop the initial care plans. Standard 6 is not applicable to this home. EVIDENCE: Case files of newly admitted service users were looked at in two of the houses. Community care assessments were on file, and the information contained in these and in other reports had been used to develop the care plans. Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Service users’ needs are set out in care plans, and the standard of record keeping has improved, and is more consistent across the four houses. Training has been provided so that staff can meet specialist health needs, such as palliative care. Regular audit of medication administration charts, and care plans has resulted in any mistakes being picked up quickly, and rectified. Service users feel that they are treated with respect, and that their needs are met. EVIDENCE: Some service users were asked for their views and care plans were examined, and discussed with staff. Staff were indirectly observed carrying out their duties. Medication administration charts were examined in two of the houses. Records of complaints, accidents and incidents were examined. Seven Requirements set at the previous inspection related to these Standards, and all have been actioned. The home has a comprehensive system of assessment,
Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 10 care planning, and recording, which is now being applied more consistently across the four houses. A pharmacist specialist unannounced inspection was carried out on 9 and 10 June 2005, and a number of Requirements were set. This was followed up by a later visit when all were found to have been met. Staff have received training in grief and loss, and nurses have attended a training session at the local hospice in order to meet the health of service users who have transferred to the home from there. Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not tested on this visit. However evidence from the last inspection was that service users have a lifestyle that, as far as possible in a group living environment, and taking account of disability/illness, matches their expectations and preferences. Friends, family, and the local community are encouraged to take part in the life of the home. Service users are helped to exercise choice and control over their lives. EVIDENCE: The above Standards were not specifically tested on this visit, as there were no outstanding Requirements. These Standards will be re-tested at a future inspection. Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 12 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 Complaints are taken seriously, and, were necessary, managers external to the home carry out investigations. Complaints received since the last inspection have been appropriately responded to, but where the Commission request a report it must be comprehensive. The home is still not taking a robust approach to identifying the cause of all injuries. EVIDENCE: The complaint records were examined and discussed with the manager. Two current adult protection investigations were also discussed. The manager, at the request of the Commission, is currently preparing a report on one of these and the required content was discussed. All such reports must include details on how the matter was investigated, including who was interviewed, what the conclusion was, based on what evidence, and what action has been taken to redress the situation. This is Requirement 1. Body charts are always completed when injuries are noticed, and an accident report should also be filled in. In one case on Ford House this was not the case, and there was no evidence of any inquiries as to how the injury occurred. All injuries must always be followed up in order to try and identify the cause. This helps to protect both service users and staff. This is Requirement 2. Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 13 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 24 & 26 Service users live in a safe, well-maintained, and comfortable environment. The redecoration and purchase of new furniture and curtains in Ford House has improved the environment. The home is clean, pleasant and hygienic. EVIDENCE: The building was toured, and a small number of service users were asked for their views. In response to a Requirement set at the previous inspection Ford House has been redecorated, and new chairs, and some new curtains have been purchased. Attempts have been made to make this house more homely by the purchase of pictures. All this has greatly improved the environment. Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 14 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): 29 & 30 The home follows a robust recruitment procedure, which protects service users. Staff are trained and competent to do their jobs. EVIDENCE: Three staff files were examined, and the induction process was discussed with one member of staff. The home obtains a POVAfirst check prior to new staff starting, and they then work under supervision till the full CRB check is received. There was proof of identity, permission to work, and two references on each file. A standard induction programme is followed, which includes discussions with a more senior member of staff. Training in Moving and Handling, Health and Safety, Loss and Grief, infection control, palliative care, and dementia care has been held since the last inspection. Two members of staff on Ford were asked about the dementia training, and how they had applied it to their direct care work. Both described how they felt more able to deal with difficult behaviour, by understanding each individual service user, and by allowing them to do things at their own pace. Twenty five care staff, out of a total of 71, currently have NVQ2 or above. A further 17 have been put forward, with five due to start imminently, and the others will start once some further basic training has been organised. The home should therefore meet the target of 50 of care staff trained at this level by 31 December. In discussion the manager reported that BUPA do not offer training to bank staff, but the Standard clearly states that any agency staff are to be included in the 50 . The manager agreed to discuss this within the organisation.
Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 15 Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 16 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 The home is well run in the best interests of the service users, and their financial interests are safeguarded. The health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: The Registered Manager has now been in post for nearly a year, and has gradually improved the management of the home. There is evidence of her regularly monitoring such things as accidents, and providing written feedback to staff where there are omissions. She has just completed the Registered Managers Award, and is waiting for her portfolio to be assessed. She has attended a range of clinical and management training courses during the past year, including customer awareness, disciplinary and grievance, and wound management. She is a first level nurse. The management of such a large home was discussed, including the need for the senior nurses, who are in
Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 17 charge of each house, to receive management training. This is currently being discussed with senior management. In most cases relatives are responsible for service user’s money, but where this is not possible the placing local authority act as appointee. There are currently three applications going through the Court of Protection. The home’s administrator maintains comprehensive records of all personal allowances sent through by the local authorities, and these records were checked. The money is kept in one bank account, but each service user has a separate record of income and expenditure, and interest is allocated to each on a monthly basis. The administrator carries out monthly reconciliation, and BUPA carry out internal checks on a regular basis. Receipts are obtained for all purchases. Regular Health and Safety checks are carried out, and all required certificates are up to date. Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP16OP18 Regulation 13 (6) & 22 Requirement Timescale for action 31/12/05 2 OP18 13 (6) Complaint investigation reports requested by the Commission must include details of how the complaint was investigated, what the conclusion is, based on what evidence, and what action has been taken to redress the issue. Where body charts are 31/12/05 completed when injuries are noticed it must be clear that attempts have been made to identify how the injuries have been caused. Accident reports must always be completed. 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 Chaseview Care Centre DS0000015586.V264669.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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