Inspection on 17/05/06 for Chaseview Care Centre

This inspection was carried out on 17th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chaseview Care Centre 25/01/07

Chaseview Care Centre 14/11/05

Chaseview Care Centre 26/05/05

Chaseview Care Centre 15/12/04

Chaseview Care Centre 26/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Chaseview Care Centre Off Dagenham Road Rush Green (hospital Site) Romford Essex RM7 0XY Lead Inspector Stanley Phipps Key Unannounced Inspection 17th May 2006 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 Chaseview Care Centre DS0000015586.V295412.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. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 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 www.bupa.com BUPA Care Homes (CFHCare) Limited 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 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.V295412.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 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 and the fees range from £600. - £700 for residential and £750 £850 for nursing with the RNCC element to be deducted following the nursing assessment by the Primary Care Trust. A copy of the Statement of Purpose and Service User Guide to the home is made available to new residents and their families and copies of these documents are available on the main reception and on each unit. A copy of the Service User Guide was in each bedroom and copies of the most recent inspection report is on each unit, and available on request. 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.V295412.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was undertaken by three inspectors to ensure that the home was given a detailed assessment, taking into consideration the wide range of service users that are in receipt of care and support. This included assessments of the dementia, residential and two nursing units. It was the first inspection within the new inspection year 2006/07 and all the key standards were assessed as well as most of the nonkey standards. The inspection found that there were some areas of good practice and this was supported by comments received from service users and their relatives, as they relayed their experiences in relation to using Chaseview. However there were a number of areas that required improvements, some of which were also identified by service users and their relatives, whilst others were identified by the inspectors. It should be noted that experiences varied on the various units i.e. Harts (residential), Kennedy and Nicholas (nursing) and Ford (dementia) and they are represented in the body of this report. Unfortunately, where good practice is inconsistent across the home, and good practice is undermined by poor standards, the overall assessment for the outcome standards leads to a lower rating. Due to the illness and mental capacity of the service users on Ford House it was difficult for the inspector to have meaningful discussions with them, as to their views of the home and care being received. What was clear was that the standards in the outcome groups for service users living in different parts of the home varied in quality. As a general observation one of the tasks for the registered persons would be to work towards providing consistency in delivering and maintaining quality care at Chaseview. The inspection also included discussions with the senior persons in charge of each unit, detailed discussions with the registered manager, interviews with staff, conversations with residents and visitors to the home and an assessment of records to include: staffing recruitment and training records, rotas, financial, service user plans and daily records, complaints and records pertaining to health and safety. A tour of each unit was undertaken and this included the kitchen, laundry and external grounds. What the service does well: Despite being a large home i.e. 120 beds, the design of the building with four separate units does not make it feel as big. Each area has its own team of carers and nurses and this allows for the staff and service users to get to know each other well. This is significant given the limited verbal communication exhibited by some service users. The set up of one residential, two nursing and a dementia unit allows for individuals whose needs change, to possibly have the opportunity to remain in the home – as they could be transferred if Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 6 appropriate to another unit. In essence, this could minimise the disruption in their lives. In general the home is bright and airy and in a good state of repair. Service users benefit from having an en-suite toilet and it was evident throughout the home that they were supported to personalise their bedrooms with personal effects, items of furniture, as well as choosing their colour schemes and bedding. Service users have access to communal spaces both indoors and outdoors, including the use of two sensory gardens, which are pleasant. There continues to be a useful assessment and care planning system, although the latter could be enhanced further. However service user needs are identified and this allows for them to be met. The home maintains professional links with specialists e.g. the Tissue Viability Nurse, a Speech and Language Therapist and a Specialist Parkinson’s Nurse. This is particularly important in promoting and maintaining the health and welfare of service users living at Chaseview. From speaking with relatives and service users across all areas of the home, the general feedback was that staff treated them with respect and worked extremely hard to provide a good service. This is despite comments like, ““staff do not always understand what we (relatives), or the service user, are saying because we are East Enders and use a lot of slang words” or “ the care is good, but it would be nice sometimes if someone came to my room for a chat”. What has improved since the last inspection? There was some improvement in the detailing of how complaints are investigated which included the conclusion, the evidence and action for improvement and this would go a long way into reassuring relatives and service users that there complaints are handled robustly. Staff were observed throughout the day mobilising service users in wheelchairs with the footplates in place and this ensured the safety of the individuals involved. It was also observed that staff were improving the quality of information provided to the Commission under Regulation 37 of the Care Homes Regulations 2001. The notifications provided more detail about occurrences in the home that affected the welfare of service users. This is positive. As stated earlier, care planning, though requiring further improvements, continued to show signs of getting better and service users stand to benefit from this progress as their needs would be more pertinently provided for. Finally there was some improvement with regards to the observation that body maps were completed following an accident or incident and accident forms are routinely completed. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 7 What they could do better: The registered persons need to ensure that information contained in the home’s statement of purpose and service user guide complies with the requirements of the National Minimum Standards and Care Homes Regulations 2001. Examples included ensuring that the management structure of the home is updated, ensuring that the correct registration conditions are detailed, together with the arrangements for the delivery of all services at Chaseview including dementia and palliative care. It must also be made clear in the documents that currently the care home does not undertake the repair of clothing and that this is the responsibility of either the service user or their relatives/friends. The registered persons also need to consider appropriately formatting the documents for the benefit of those service users with Dementia. It is essential that the registered provider ensures that all service users are given clear documentation as to the terms and conditions of placement at Chaseview as required by the Care Home Regulations and National Minimum Standards. Since the time of the visit discussions have been held with the operations manager and her line manager regarding compliance with in this area. It was agreed that some form of providing the required information to service users would be explored, by the organisation. The registered persons need to provide clear and consistent evidence that the assessed needs of service users are met across all areas of the home, as there were cases when the recording of interventions made by staff were not up to standard – and as such failed to show this. This failure could have serious implications on the health and welfare of service users. It should be noted that the recording of medication is also included in this area of improvement. Similarly service user plans across all areas of the home need to be consistent in identifying and indicating how service user needs are to be met. This includes including the healthcare needs in the case of Harts House and the social care needs of service users on Ford House. It is also imperative that the cultural needs of service users are identified and provided for. The latter is particularly important as in one case on Ford House, there was no evidence that skin products specific to the needs of the service user were considered, far less provided. The service user plans must also include ‘ end of life’ plans for service users’ to ensure that their wishes and aspirations are catered for should this event occur. More specifically the registered persons need to keep under close review, the needs of those service users on Ford House in which a number of them had high nursing needs, which meant that their care would be best provided on one of the nursing units. Equally, it is important that admissions to the nursing units for service users requiring palliative are reviewed to ensure that the staff are equipped with the training to provide a consistent and quality service to them. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 8 Another area that could be improved is that of safeguarding service users’ personal effects e.g. dentures, spectacles and hearing aids of service users particularly on the dementia unit. The loss of such items may add to confusion for service users as well as them not eating well. More could be done with regard to the social activities on the nursing and dementia units, in order to provide greater stimulation and hence a better quality of life for service users living on them. Though the quality of food throughout the home was satisfactory, arrangements for feeding service users, particularly those who are more dependent e.g. those on the nursing and dementia units need to be reviewed, to ensure that mealtimes are both a safe and enjoyable experience. Staff supporting service users, for example, must be appropriately trained. Despite improvements in how complaints are handled, further improvement is required to ensure that all complaints whether verbal or written are recorded. It is also important that the complaints format be adapted for the benefit of service users with dementia care. There were a number of improvements required to the environment, some of which were minor while others were more significant. One example that was common throughout the service was the heavy staining of the carpets in the corridors. Another is the use of non-carpet surfaces in areas of the home where incontinence was an issue. Fuller details of the improvements to the environment are detailed in the body of the report. With regard to staffing, improvements are required around their deployment and training, particularly in relation to dementia. Finally whilst it is acknowledged that the there have been improvements since the registered manager has been in post, it was clear that a number of areas could be improved to ensure a high standard of service provision at Chaseview. Examples of such areas included the time taken to repair and/or replace broken equipment in the home and issues around the implementation of BUPA’s equal opportunities procedures. 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.V295412.R01.S.doc Version 5.2 Page 9 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.V295412.R01.S.doc Version 5.2 Page 10 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): (1,2,3,4,5) Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to this service. Service users have information on which they could determine whether the home is suited to them. They and/or their relatives are also able to visit the home prior living there and would only so do, once a detailed assessment is carried out on their needs. Service users would however benefit from having updated information and where possible in a format that they could relate to. They would also benefit from having a copy of terms and conditions about living in the home, so that they are clear about their responsibilities and those of the organisation. Standard 6 does not apply to this home. EVIDENCE: A statement of purpose and service user guide is available to service users throughout the home, however this must be brought into line with the Care Homes Regulations 2001. The manager must ensure that the correct registration conditions are detailed, together with the arrangements for the delivery of all services at Chaseview including dementia and palliative care. It Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 11 must also be made clear in the documents that currently the care home does not undertake the repair of clothing and that this is the responsibility of either the service user or their relatives/friends. The management structure of the home should reflect the current position and consideration should be given to presenting this document in a format that would benefit service users with dementia. During the case tracking of service users’ files it was evident that these did not contain a copy of the statement of terms and conditions. In discussions with the manager it was evident that such a document is not routinely given to service users or their relatives unless they are funding their care privately. Most service users appear to be funded by a local authority, and services are commissioned at Chaseview under an umbrella contract with the local authority. However, it was clear that the registered manager did not know if the local authority provided a copy of the umbrella contract to service users. It is essential that the registered persons ensure that all service users are given clear documentation about the terms and conditions of placement at Chaseview as required by the Care Home Regulations and National Minimum Standards. From the case tracking of fourteen service users across the home it was clear that pre-admission assessments were in place for each individual. This information is then used to develop a service user plan and where appropriate information from the placing authority was in place. It would be more beneficial to service users particularly on the dementia unit (Ford) for more detailed needs to be obtained around a person’s existing abilities with regard to ordinary activities of daily life and life histories. This should then be incorporated into the service user plans to enable the staff to provide the right level of care, in all aspects, to assist the service users to continue to live as full a life as is possible, and for as long as possible. From speaking with relatives, they indicated that they had opportunities to visit the home prior to admission or while contemplating the suitability of the home for their loved ones. They also confirmed that they were in receipt of written information about the home. As stated earlier this information needed updating. Relatives also benefited from having a tour of the facilities. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 12 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) Quality in this outcome area is poor. This judgement has been made using the available evidence, including a visit to this service. An individual plan of care is drawn up for meeting the needs of service users. However, practice is inconsistent across the home, and good practice in some areas is undermined by poor practice in others. If residents’ needs are to be properly met, care plans need to detail the healthcare needs (Harts), social and cultural needs (Ford) including the ‘end of life’ requirements, for all service users. The provision of healthcare needs of service users, in some cases was good, whilst in others the quality of the provision could be enhanced. Support with medication is generally good, but requires further improvements to ensure the safety of all service users. Service users generally benefit from being treated with dignity and respect. EVIDENCE: It was clear that service user plans were in place for all individuals living in the home and this had been improved over the previous inspection visits. They were reviewed monthly, fairly detailed and reflected the changing needs of individuals. However there was one case on Hart House (residential) where the needs of a diabetic service user were not recorded in the service user’s plan. This is a health care need, which must be reflected regarding the interventions Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 13 that staff are required to make. On Ford House the service user plans were primarily based around the physical healthcare needs of service users and nonspecific to their Dementia needs. It was also observed that there were no ‘end of life plans’ in place for service users and this was common to other aspects of the service. This aspect of record keeping needs improving. It is also important that the ethnic, cultural and religious needs of service users are represented in the service user plan as in the case of one service user whose skin care would have been enhanced – had his ethnicity been taken into account. Crucially service user plans need to be individualised. One positive observation was that there were night routines and mouth care plans in place for some service users. On Ford House (Dementia Unit) it was observed that the service user plans did not always show evidence of a person’s current ability and level of functioning, staff were not always able to ensure that the correct care was being given to service users, nor if they were still appropriately accommodated on Ford House. A high proportion of service users on this unit have very high nursing care needs which often outweigh the dementia care needs, and it is essential that the manager reviews such cases to ensure that the environment is still conducive to the care of these service users or if they would be more appropriately placed on an ordinary nursing unit. The quality of care experienced by a person living with dementia can be improved by the way staff use and understand service user plans. A comprehensive service user plan, covering both health and social care needs, can only enhance the care experience of a service user living with dementia. Because the label of “dementia” tends to prompt negative responses, service user plans tend to be couched in terms of risk, dependency or disability. The assumption that people with dementia cannot do much leads to dependence on care staff to do tasks that they could actually be doing themselves. There was some evidence that some background history regarding previous activities enjoyed by service users was recorded, but there was no evidence that such information is used in a meaningful way in the delivery of social care. One service user plan indicates that she is in danger of absconding from the unit and a risk assessment is in place to ensure that she is regularly observed in case she leaves the unit. However, it may be more beneficial to this service user if she was taken for a walk in the community on a daily basis, and efforts made to listen to her reasons for wanting to leave the unit and to incorporate this into her individual plan. The healthcare records of service users bore indication that in most cases they were appropriately identified. In both Kennedy and Nicholas for example the documentation/ health records relating to wound management, the management of a service user with diabetes and the management of a service Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 14 user with an infected wound, were detailed and being adequately maintained. The records indicated that other health care professionals and specialist nurses such as Tissue Viability and Vascular Nurse visit service users and this was common in all areas of the home where appropriate. On the day of the inspection a visiting dentist was on Ford. Further evidence that healthcare needs are provided for could be drawn for the fact that on Ford, the dietary and nutritional needs of all service users were monitored on a very regular basis and referrals made to the appropriate health care professionals when any indication of concern is observed, such as weight loss or not eating. Risk assessments were also in place for manual handling, the use of cot sides and for service users who are prone to ”walking”. Body maps are also completed following an accident or incident and accident forms are completed. However, from the close examination of a number of care records particularly on Ford, Kennedy and Nicholas, it was clear that the health care needs of service users were compromised and as such - they were not fully met. This was despite a health check audit that was carried out on 13/1/06 by the registered manager. It was common that fluid balance charts were not maintained adequately e.g. on Ford the output was not recorded, whilst on Kennedy they were sporadically filled in. In the case on Kennedy recordings for the day of the visit and the preceding two days were examined. At 11.30 hrs on the day of the visit the only recorded entry on one chart was 09.10hrs. The same chart for the service user from the preceding day showed only two recorded entries i.e. 07.50hrs and 20.10hrs. For this service user the implication is that fluids had not been given for a period of some thirteen hours. This concern was raised with the nurse in charge and she indicated that the completion of these charts was the responsibility of the care staff. If the recordings of fluid intake are indicated for a resident then this must be considered a clinical record and must be monitored by nursing staff. It is essential that all monitoring records for individual service users are maintained accurately and up to date. Discussion with nursing and care staff indicated that service users were receiving fluids but that staff were failing to record this on each occasion. The Inspector also observed fluids being given to service users during the inspection. Further evidence gathered on Nicholas confirmed that the health care needs of service users were compromised by the poor recording practices of the staff team. An example of this was where one of the service user’s plan directed that neurovascular observations to be undertaken and recorded on a weekly basis. There were significant gaps noted in the recording of these observations for example, 20/03/06; 6/04/06; 22/04/06 and 10/05/06. This is unsatisfactory and needs to improve. There were clear medication policies and procedures for staff to follow, and only the nurses are designated and trained staff had responsibility for giving medication. As part of the home’s medication policy – one service user (Harts House) was supported to maintain her independence with regard to taking her medication. This is positive and in speaking with the service user she was Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 15 absolutely delighted about this. The registered manager provided evidence of carrying medication audits – the most recent being on Kennedy (15/5/06) and this should have a positive impact on the overall standard of medication handling in the home. However improvements are still required, as there were several gaps in the Medication Administration Record (MAR) sheets in Harts House, while improvements were required in Kennedy and Nicholas. They included ensuring that: handwritten entries on MAR charts are signed and dated by the person making the entry. The entry must also include the source of the information i.e. GP, and when directions for administering medication are variable e.g. one or two tablets, then the dose given must be documented on the MAR chart. There was a strong sense and positive feedback about the respectful and dignified way in which the staff were working with service users at Chaseview. Comments received included “I am very happy and the staff are kind. I only wish I could have breakfast a little earlier in the mornings”. “I have no problems, the care is good”. Another service user who has lived in the home for years commented: “Staff are good, they work very hard”. Staff were observed on the day addressing service users by their preferred names and promoting service users privacy whilst supporting them with personal care. All relatives spoken to on the day were pleased with the level of respect that staff exhibited in the execution of their duties. Staff awareness with regard to death and dying was satisfactory and they were in receipt of training in grief and loss. However there was evidence on Nicholas that a service user who had been admitted to the home from a hospice for palliative care did not have an ‘End of Life’ care plan. As such there was no evidence that her wishes concerning terminal care and arrangements after death had been discussed. This is significant particularly given the service user group and category living at Chaseview. In essence such a plan must be in place for all service users – as a matter of priority for those receiving palliative care. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (12,13,14,15) Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to this service. Service users generally enjoy a lifestyle that is consistent with their expectations, although this could be enhanced for those with specialist needs e.g. Dementia. They enjoy having contact with their relatives and in most cases are supported to exercise control and choice in their lives. The nutritional needs of service users are generally well provided for. Some improvement is required to enhance choice particularly for service users with specialist needs, and safety with regard to food storage in the home. EVIDENCE: There appears to be a general programme of activities for the home and it was clear that service users on the residential unit (Harts) by virtue of their relative independence benefited from it. One of the most recently admitted service users spoken to on this unit gave vivid accounts of using the sensory garden with its flowers and waterfalls, going to the theatre to see ‘Me and My Girls’ and going to Southend for a day in July. She also spoke of an upcoming ‘Faith’ in the home that was scheduled for July 2006. Religious services are held in the home and service users exercise choice in attending. Internally activities included bingo, arts and crafts, cake decorating (observed on the day although service users were not directly engaged), board games, indoor bowls, visiting entertainers, music and viewing television. There is also a men’s morning and Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 17 women’s morning where they get together and chat, which was described affably by one service user as “gossip”. The home also has two activity coordinators who organises the activities in the home. A number of service users also had the benefit of having personal videos and stereos in their rooms, which provides them with an alternative if required. It was reported that the home offers therapy sessions such as aromatherapy and massage at an additional cost. It is however extremely important that more consideration given to the specialist needs of people living with dementia. For instance more individual activities, including the use of life histories, and small group activities focusing on the individual’s needs and cognitive functioning, and adapting activities to relate the individual’s likes, dislikes, past and present and concentration span. It was not clear that there was significant service user involvement in community groups and while this might be understandable, for example, in the nursing and dementia units – the registered person must look at bringing groups in to provide more stimulation for service users. It was reported that children from the Rush Green School visit the home and this was confirmed by some of the service users interviewed. To the home’s credit a gardening club is in progress and a volunteer whose brief is to assist service users to pot plants runs this group. A criticism made by service users and their relatives on the day was the fact that they were unable to use the garden – which for them is an activity they quite enjoy. This was down to a broken lawnmower that was broken for a considerable period, which up to the day of the inspection remained unresolved. This was discussed in detail with the manager. The home encourages and promotes links with the relatives of service users and all service users spoken to were very pleased about that. To this end the visiting times are flexible and a good example could be drawn from the fact that one relative has a meal with his wife at the home for a nominal charge. This allows him to spend significant periods with his wife. There is a relatives group that meets three-monthly and a newsletter is prepared approximately every three months and sent to service users and relatives. One relative spoken to stated, “ staff make me feel welcome at anytime”. Another informed that “whenever she visits the staff treat her with respect and courtesy”. Service users could meet with relatives in either communal lounges or in the privacy of their own rooms. Most of the service users spoken to on Harts House indicated that they were encouraged to make choices in their lives and examples were given in areas such as meals, activities, the colour of room curtains and generally how their rooms are personalised. In other areas however it was not clear that service users were given a choice for example, in having the television on as opposed to music. On one of the nursing units the television was on with no volume, with music from a stereo in the background, which seemed quite confusing. The absence of picture menus for dementia care service users and lack of appropriate signage on some bedroom doors, for example some had no Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 18 identifying methods such as pictures familiar to the individual, restricts the ability of service users to locate their own bedroom thus restricting choice and control in their lives. This needs to improve. The meals were well presented, even though many service users were on a pureed diet. However, service users living with dementia may benefit from the use of, for example, picture menus, finger foods, small nutritious snacks and more flexible mealtimes to maintain independence, exercise choice around food and eating and still provide a healthy balanced diet. Service users on the residential unit were mostly able to have their meals independently and those who required support were given this with dignity and sensitivity. Where possible relatives provided assistance to their relations as necessary and this seemed to work quite well. It was observed on one of the more dependent units that one of the activity coordinators and a maintenance staff were involved in feeding. It was determined that whilst the former had training, the maintenance person did not and, as such, this could be unsafe practice. Staffing levels and expertise must make the experience of eating meals safe and pleasant. Meals are served in the dining rooms or service users may choose to eat in their rooms. During the inspection on Ford the Inspector observed that during lunch the majority of service users remained in the lounge chairs and were either fed or ate their meal from small tables placed in front of them. However, it was not clear if this was through their choice. Service users should be encouraged to move to dining tables for meals as this will help with mobility, digestion and hopefully make meal times more enjoyable and a social occasion. Dining tables on Ford although covered with a tablecloth, were not routinely laid to make the eating of meals a pleasant visual experience. It is acknowledged that once tables have been laid there may be some service users who then proceed to move things, which makes extra work for staff in relaying the tables. Staff should discuss this to agree on strategies to distract service users rather than act negatively by not laying tables. Staff were observed to be on hand to assist service users with eating when necessary. The majority of the thirty service users on this unit needed either supervision by staff or assistance with eating, and staff were observed to be offering assistance appropriately and service users were not being rushed. However, staff also had to attend to service users who had lost interest their food, offer encouragement and reminders to eat and attend to those who were wandering from the dining table. This also strengthens the case for the reviewing the staffing levels and their deployment at mealtimes. Feedback from service users and their relatives indicated that hot and cold drinks were available throughout the day and night where required. There was Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 19 a case where, in one of the satellite kitchens yoghurt was found out of date and stored in the fridge. This needs to improve. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (16,18) Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to this service. Service users and their relatives have access to a complaints procedure. However, not all residents would be able to use the formal process. Only formal complaints are recorded. This means that service users and their relatives cannot be confident that informal complaints, concerns and expressions of dissatisfaction are listened to and responded to. Adult protection training and protocols are firmly in place to promote the safety and welfare of service users. EVIDENCE: The home’s complaint record was examined and it recorded complaints received since January 2006. The Inspectors discussed with the manager as to what constituted a “complaint” to be logged, as it would appear that neither verbal complaints nor concerns are being recorded in the complaints book. All complaints made whether, written or verbal via telephone or face-to-face, or expressions of concern or dissatisfaction with any element of the service must be recorded. Unless all concerns or complaints, however made, are accurately recorded together with the action taken to address them, the manager will not be able to ensure that service users, relatives and friends will be confident that that they will be listened to and taken seriously. Concerns/ complaints/ compliment monitoring should form part of the quality assurance of the home to ensure that the needs of service users are being met. Following the inspection visit, feedback was received from a relative who had raised concerns about the care of his mother with the registered manager. He explained that the registered manager failed to provide him with a complaints Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 21 form or to point him to the home’s complaints procedure. It is important that relatives who wish to or express a concern are provided with the reassurance and guidance that they have the right to so do. Ironically four members of staff were interviewed on Harts House and they all demonstrated a clear understanding of service users’ right to complain and their role in enabling them to so do. Adult protection procedures and protocols were in place at the home. Staff have had training in adult abuse and this was borne out in interviews held with a sample of them. There was an improvement in this standard in that accident reports are more thoroughly completed and greater efforts are made at identifying and stating how injuries are caused. It should be noted that at the time of compiling this report there were up to three adult protection matters in progress, one of which was initiated just prior to the inspection. There are no conclusive outcomes although the investigation of two cases had been initiated towards the latter part of 2005. Attempts to ascertain the state of the longer standing matters from the lead authorities have not yet produced evidence of the outcome of their investigations. There were no referrals to POVA during the last inspection year. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 22 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): (19,20,21,22,23,24,25,26) Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to this service. Service users live in an environment that is generally well maintained, although improvements are required. The standard of décor is good and each bedroom was personalised. Adequate toilet and bathing facilities are in place though bathrooms are used as storage for equipment. Specific improvements are required to the environment to ensure the independence of service users with specialist needs. A review of key systems is required to ensure the safety of service users living in the home. EVIDENCE: There is a feeling of spaciousness as you enter the home, which was generally in a good state of repair. The standard of the décor, furnishings and fittings were generally being maintained to reasonable standard. However it was observed that some carpets were heavily stained particularly along the corridors. The manager informed that this was because the carpet-cleaning machine was broken and the inspectors expressed concern over the time it was taking to have this repaired and/or replaced. The same was true for a broken lawnmower, which was the concern for a number of service users and Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 23 their relatives as the grass was high and the garden could not be used by the service users. They were not happy with the arrangements and the time it was taking to have it resolved. The delays were explained to problems with the system of ordering however there seemed to be a lack of contingency arrangements to e.g. renting a carpet cleaning machine or the rental of a lawnmower to temporarily resolve some of these problems which adversely impacted on the welfare of service users. This needs improving. Generally service users were observed using mainly the indoor aspects of the home safely and comfortably. More appropriate arrangements could be made for the service users with Dementia so that they would be better able to be in tune with their environment. As the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope better with daily life. The general environment on Ford House did not reflect current good practice guidance on dementia care within care homes. A copy of the Commission’s “Dementia care within care homes guidance” was given to the senior sister. In this respect consideration must be given to utilising the existing design and layout of Ford House to meet the specialist needs of people living with dementia. For example: through the use of visual cues such as colour and signage. Containers with suitable materials could be located around the unit so that those service users who can walk can touch and feel things. The use of calming equipment such as lighting or a small aquarium could be used. Staff must also be aware of factors such as noise. On the day of the inspection the majority of service users were seated in the large lounge/dining room, and noise from the television was competing with service users shouting, staff and service users talking, meals being served and so on. This can be very distracting for service users and can have a direct impact on their behaviour. Although there are two lounges, the large lounge/dining room and a smaller quiet lounge, only the large lounge/dining room appears to be in use. The smaller quiet lounge appears only to be used by visitors. Much more thought must be given to the use of the communal spaces, since many of those service users who are quite poorly would benefit from sitting in a quiet area. Consideration must also be given to the layout of seating areas in the large lounge as relatively few service users could actually see the television, which was located high on a wall. One service user who was very frail, with little mobility and blind was actually seated almost under the television and had no means of moving to a quieter area. It appears that staff feel that if the television is on service users are being entertained, irrespective of what programme is actually being shown since channels are very rarely changed. There were adequate toilets and washing facilities throughout the home and service users were observed accessing them in the main with great ease. More could be done however with regard to the Dementia unit (Ford) as stated Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 24 earlier in this report with regard to signage and décor that would assist those service users to identify and make use of those facilities. There were areas requiring repair e.g. on Kennedy there was a broken bath panel in bathroom 35 and in WC 7 the shower curtain was torn and hanging from the rail. On Nicholas, shower 7 – the shower tray was rusty in several places and in the satellite kitchen the microwave was encrusted with food particles. It became apparent from talking to staff that the manager needs to ensure that there is an effective system in place for staff to report items requiring attention or repair. The home provides equipment e.g. hoists and wheelchairs in providing care and support to service users. In talking to one service user the remark was “sometimes when I want to use the toilet I have to wait for a long time and I am the told that the hoists are in use”. This was fed back to the manager who informed that this matter was in hand. During the visit, it became clear that bathrooms were used for storing wheelchairs, hoists and other sundry items of equipment. This practice must be reviewed in terms of safety. Generally service users’ private rooms were in a good state of repair, clean and designed to meet their needs. All bedrooms were accessible and most service users spoken to were happy with them. Service users were encouraged to bring in their personal possessions and rooms were personalised, which had a positive impact on a number of service users spoken to. Call alarm systems are provided but it was noted that alarms in some rooms on both units (Kennedy and Nicholas) were either out of reach, not connected or absent. Alarms must be accessible to service users at all times unless a completed risk assessment dictates otherwise. If so the reasons why must be recorded with strategies in place to enable a service user to call for assistance when required. It was observed that some bedrooms had carpets and some had a non-carpet floor covering. The reason given was that some service users were incontinent and non-carpet floor covering made the cleaning easier. The manager is requested to review this practice since it is a form of “labelling” and there are carpet-like materials, which are stain resistant together with modern cleaning products. Generally, with proper continence management accidents can be avoided. There was adequate heating and lighting in the home and service users were generally comfortable living there. Ventilation in the home and bedrooms had some element of natural lighting. Emergency lighting is provided throughout the home water storage and temperature checks were in line with requirements, thus making the home safe. A visit was made to both the kitchen and laundry and they were both maintained to a good standard. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 25 However, one large freezer was broken and awaiting replacement. This obviously was causing storage problems but the catering staff were managing this effectively. Food was appropriately labelled and stored in the main kitchen The laundry staff were aware of when to use protective equipment and hazardous substances were being appropriately stored. However, one tumble dryer had broken and was awaiting replacement. The home was free from offensive odours and policies and procedures were in place for the control of infection. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 26 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): (27,28,28,30) Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to this service. Service users are generally well supported by staff at the home, although this could be enhanced through a more strategic deployment of them. They also benefit from the robust recruitment practices of the organisation and the training programme for staff compliments this. However the general and creative use of staff in the home must be enabled through appropriate training to promote the health, welfare and safety of service users. EVIDENCE: The staffing levels throughout the home are generally adequate. The numbers of qualified nurses and care staff on both the Dementia (Ford) and Nursing Units (Nicholas and Kennedy) were sufficient to meet the nursing needs and personal care needs of service users with the exception of mealtimes when it was evident that additional staff were required at this peak activity time. Two members of care staff on each unit are also responsible for collecting and returning the hot meal trolley at each mealtime from and to the main kitchen. This effectively means that the staffing levels on the units are depleted by two on each occasion. Care staff should be wholly engaged in the care of service users and it is strongly recommended that care staff should not be undertaking portering duties. During this peak period it was also observed that one of the activity coordinators and a maintenance staff were involved in feeding. On further examination the latter had no training and this could be detrimental to service users with specialist needs. This needs to be addressed. On Harts House (residential), during staff interviews, it was disclosed that when the nursing units are short, on most occasions they take away one member of staff Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 27 from this service. This leaves the service short and not only impinges on the delivery of care for that service, but also puts the health and safety of the staff and service users at risk. Evidence was provided via the rosters on the day of the visit. This practice needs to cease and appropriate arrangements made to cover staff absence. It was also noted that this has an adverse impact on the morale of staff working on Harts House. In addition to qualified nurses and care staff, the home employs activity coordinators, catering, laundry, domestic, maintenance and administrative staff. Catering staff spoken to indicated that currently they have time to undertake all of their duties but that in the near future some hours would be being reduced. The manager and head chef would need to monitor this in case of some areas being neglected. The catering staff are responsible for the small kitchen areas situated on each of the four houses. Although there are always two laundry assistants who each work 8 hours per day, they are kept busy with washing and ironing clothes and bedding for 120 service users. Again the Inspector was informed that some hours had been reduced, and that the repair of service users’ clothing was not done. If they had time they might sew on the odd button or “Wonder Web” a hem that had come undone but that the responsibility for repairing clothing was that of the service users or their relatives. There was no evidence that this was clear to service users or their representatives, for example, in their terms and conditions or the Service User Guide. There was evidence provided by the home to confirm that up to fifty nine per cent of the care staff had achieved their NVQ Level 2 Award in Care. This exceeds the minimum standards, and also ensures that service users are supported by staff that have some understanding of care. This is positive as an outcome for service users. The personnel files of eight (8) care staff were viewed and it was evident that the organisation’s recruitment processes are robust. Evidence found that references are taken up and that criminal records bureau disclosures are obtained and this is also a positive outcome for service users in terms of their protection. The registered persons have a system in place to facilitate the training and development of staff in the home and a number of staff have been provided with training that is specific to the service requirements. Some of training provided included: Manual Handling, Managing as a coach, Managing Relationships, Risk Assessment, Care Planning, Managing Aggression and Challenging behaviour, Abuse Awareness, Understanding Dementia, Infection Control, First Aid and Managing Negotiations. However it is of vital importance that any non-care staff, that are involved in feeding service users – receive appropriate training to so do. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 28 With regard to the Dementia Unit, it was observed that the senior sister undertook an intensive training course during 2005 in the care of people living with dementia and is endeavouring to cascade this down to care staff. However, time must be allowed for this cascade training to ensure that it is effective and beneficial to staff and then to service users. Care staff must be supported and enabled to develop the skills, knowledge and abilities required to successfully enable service users to continue to exercise choice in their daily lives and reach their full potential. All care staff working on Ford House, which is offering specialist, nursing care for people living with dementia, must receive comprehensive and certificated training in caring for people living with dementia. In discussion with the nursing staff on Nicholas, it was disclosed that the home is receiving an increased number of referrals from a local hospice to admit service users with palliative care needs. There have been a number of issues highlighted as a consequence of these admissions that nursing staff are trying to resolve. For example, many nurses working within palliative care services are “nurse prescribers” who have an extended role, which allows them to independently prescribe a range of medications to patients and undertake additional tasks, related to for example, pain management and re-hydration. The registered nurses in Chaseview do not have this extended role or training and have to make contact with the GP each time they wish to increase medication and have to admit service users to hospital when they require rehydration. Nurses working on this unit have recently undertaken training in the use of syringe drivers, but have had no other training specifically in meeting and understanding the needs of service users requiring palliative care. It was acknowledged that the nursing staff are well supported by the hospice nurses. The registered persons must ensure that staff have the required skills, experience and training to deliver the specific service and care which the home offers to provide to residents with palliative care needs. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (31,33,35,38) Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to this service. An experienced manager is in place to lead the service, although there is room for improvement with regard to the current management arrangements in the home in order to ensure that the good practice in individual units is reflected consistently throughout the home. Generally the home is run in the best interests of service users and the financial arrangements in the home are sound. More could be done to promote the health and safety of service users in the home. EVIDENCE: The registered manager is a first level nurse, and has completed her Registered Managers Award. There was also evidence of her undertaking clinical and management training to update her skills and knowledge. Prior to this inspection the registered manager informed the then lead inspector that ‘ white staff would not work on Ford Unit. During the course of the inspection it became clearer that there was an issue on the Dementia unit and the issue of Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 30 the prevalence on black staff working there was raised with the senior nurse on duty. There was confirmation that white staff did not like to work on Ford, but that the reason was unknown to the senior nurse. The inspectors then raised with the registered manager about the noticeable prevalence of black staff working on Ford (as there was only one white staff member working nights there). The response was that white staff are employed to work there, but once there, they would ask to be moved. It was not clear that black staff were given a similar opportunity. The registered manager was asked why and she informed that the behaviour of the service users with Dementia was a challenge to white staff, which some were refusing to accept. The manager gave an example that white staff said they did not like being scratched by the service users. When asked what the manager would do if black staff refused to work on this unit, the manager stated: “they have not refused to work on Ford”. This question was raised several times and the response was the same that – ‘they had not refused to work on Ford’. This indicates that the manager had not grasped the significance of the issue. In further discussion with the manager, she was asked how she would support an individual who did not want to work on Ford House. Her response was to move the staff and in the same breath, asked what else could she do. One response from all three inspectors was to provide support and training to understand and meet the challenges of this unit. The registered manager did not refute the issue of white staff choosing not to work on Ford, and seemingly supported them to so do. This is unacceptable practice and is discriminatory. The manager may wish to seek guidance from her line manager in dealing with this issue to ensure staff competence and non-discriminatory practice. The Inspectors were extremely concerned that strategies were not in place to manage this situation effectively and to ensure that BUPA’s equal opportunities are fully implemented. Feedback received from a care manager placing with the home informed that the ‘extreme prevalence of black staff on this unit is quite glaring when you walk into the home’. This reality would adversely impact on staff morale and staff relations in the home – much of which is internalised. During the course of the inspection, albeit on a different unit (Nicholas), two relatives informed that, “staff do not always understand what they, or the service user, are saying because we are East Enders and use a lot of slang words.” This is another example of where there may be an issue of English not being staff’s first language which could be dealt with through training. Staff could be reassured that they do not have to tolerate slang or forms of language that may be offensive or that they don’t understand. Forums such as staff meetings and service users’ and relatives meetings could also be used to set out clearly how the home applies its equal opportunities policy. In addition to the issues around equal opportunities, there was an apparent lack of communication between the manager and staff. This became clearer when in discussion with the manager she refuted the reported reduction in Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 31 hours in both the kitchen and laundry. It is important that communication is at its optimum particularly when it involves the head of service. It was acknowledged that the home had recently recruited a deputy manager who stayed in the job for one month. Chaseview is a large home and as such there needs to be more regular interface between the management of the home and the heads of units. The inspectors were informed that advertisements went out on the 16/5/06 to fill this vacancy, which could go a long way in dealing with some of the issues raised earlier. There was evidence that the manager had stepped up monitoring various aspects of the service and records of management meetings were presented at the inspection. It was noted that a number of audits had taken place, towards monitoring and ensuring quality in the home. As stated earlier a key part of this must involve being robust in embracing and dealing with concerns and complaints. There was also good evidence to confirm that monthly provider visits to the home are regular and deal with matters as they arise in the home. During the course of the inspection it was discovered that there has been a cut in the catering budget from £2.36 to £2.31 and the manager indicated that this was due to a reassessment of the funds spent on ‘frills’ that were not seen as needs. It was not clear about the consultation process with service users and/or their relatives and initial evidence from service users and their relatives did not allude to either a reduction in the quality or quantity of food provided to service users. The Commission will monitor this at future inspections. The inspectors were satisfied that service users’ financial interests are safeguarded and that the home’s administration and record keeping protects service users’ best interests. All service users who have a personal account with the organisation receive interest on monies held which is credited to their account on a monthly basis. All maintenance records, including fire safety, lift maintenance and water temperature checks, were viewed and found to be up to date and in good order. However there were some areas of concern relating to health and safety that required improving as they compromised the safety of service users and staff in the home. There was an issue as discussed earlier, with the length of time taken to repair and/or replace broken equipment in the home. A key example of this was where the hot water facility on Harts House was broken and while service users were still having hot drinks, many reported that it was taking some time. This was because the hot water had to be transported from upstairs. One service user spoken to, found it unacceptable and stated that ‘when you raise it with the manager – she replies it is in hand’. She also stated that ‘it is unsafe for staff transporting hot water in this way’. There was no evidence that risk assessments were undertaken as such it is required that contingency arrangements of this nature to be risk assessed with records kept. During the inspection it was also observed that a number of fire doors were propped open and while this may be associated with the choices of service Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 32 users, it attracts a significant risk in the case of a fire. If this practice is to continue then, self-closing devices connected to the fire alarms must be fitted. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 33 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 1 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 2 2 3 2 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 NO Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? Chaseview Care Centre DS0000015586.V295412.R01.S.doc 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 4,5 & 6 Requirement The registered persons are required to update their statement of purpose and service user guide in line with the Care Homes Regulations 2001. It must ensure the correct registration details, including the delivery of dementia, palliative care and the arrangements for the repair of clothing in the home. The registered persons are required to provide each service user with a statement of terms and conditions of placement at Chaseview. The registered person are required to ensure that service user plans reflect residents; healthcare needs (Harts House), social and cultural needs (Ford) and, ‘end of life’ requirements for all service users. The registered persons are required to demonstrate that the assessed needs of service users are met at all times. The registered persons are required to keep under review the needs of service users on Ford in determining whether they area best met on that unit or on one of the nursing units. The registered persons are DS0000015586.V295412.R01.S.doc Timescale for action 14/07/06 2 OP2 5 31/08/06 3 OP7 15(1) 18/08/06 4 OP8 12,13 18/07/06 5 OP8 12,13 30/07/06 6 OP9 12,13 18/07/06 Page 35 Chaseview Care Centre Version 5.2 7 OP11 12(3) 8 OP12 12 (3) & 16(2)(m) (n) 9 OP14 16 10 OP15 13 11 OP16 22 required to ensure that: 1) Medication charts are signed at all times, 2) Handwritten entries on MAR charts are signed and dated by the person making the entry. The entry must also include the source of the information i.e. GP and 3) Where medication directions are variable e.g. one or two tablets, then the dose given must be recorded. The registered persons are required to ensure that the wishes of service users regarding terminal care and arrangements after death are identified and acted upon. The registered persons are required to ensure that the routines of daily living and activities are flexible and varied to suit the expectations, preferences and capacities of all service users in the home – particularly in the Dementia Unit. The registered persons are required to demonstrate that service users with complex needs are afforded choice and control in their lives e.g. use of picture menus on the Dementia Unit and appropriate signage on bedroom doors. The registered persons are required to ensure that 1) adequately trained staff are available in sufficient numbers to support service users with their meals and 2) Items of food that are out of date are appropriately destroyed. The registered persons are required to ensure that: a) all complaints- verbal or otherwise – are recorded and the action taken to address them and b) provide direction for individuals DS0000015586.V295412.R01.S.doc 18/07/06 23/09/06 23/09/06 18/07/06 18/07/06 Chaseview Care Centre Version 5.2 Page 36 12 OP19 23(2)(d) (o) 13 OP20 23(2)(h) (n) 14 OP21 23(b)(l) 15 OP22 13, 23(2) (c) 16 OP24 16(2)(c) 17 OP27 18(1)(a) wishing to complain about the service. The registered persons are 18/07/06 required to ensure that the carpets in the corridors of the home are deep–cleaned and to arrange for the grounds to be properly maintained. The registered persons are 30/09/06 required to review the layout and design on Ford unit to include the use of visual cues such as colour and signage. (See Standard 20) The registered persons are 15/08/06 required to ensure that: 1) the repairs listed in Standard 21 of this report are carried out & 2) develop an effective system for reporting repairs and 3) bathrooms are not used as a storage facility for equipment – unless a risk assessment dictates otherwise. The risk assessment (if carried out) must be available for inspection. The registered persons are 31/07/06 required to ensure that call alarms are both accessible to service users at all times – unless a risk assessment dictates otherwise. The risk assessment if carried out must be available for inspection. The registered persons are 30/08/06 required to review the practice of using non-carpet floor covering for service users with continence problems. The outcome with action must be recorded. 31/07/06 The registered persons are required to: provide competently trained staff in adequate numbers at peak times e.g. mealtimes and in the home and, to ensure that appropriate arrangements are made to cover staffing absence. (See Standard DS0000015586.V295412.R01.S.doc Version 5.2 Page 37 Chaseview Care Centre 18 OP30 18(1)(a)(c)(i) 19 OP31 12(5)(a) and (b) 20 OP38 12,13 27). The registered persons are 31/08/06 required to ensure that staff are given appropriate training in palliative care, feeding and certificated dementia care. The registered persons are 31/08/06 required to develop strategy/ies to demonstrate that the service is managed within the equal opportunities framework of the organisation, taking into consideration the experiences of staff from minority ethnic groups while working in the home. (See Standard 31) The registered persons are 31/08/06 required to promote the health and safety of service users and staff by:) conducting risk assessments e.g. on transporting hot water from one floor to another – to ensure a safe practices in the home and 2) ensuring that wedged open fire doors are fitted with a self closing device, linked to the fire alarm system. 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 Refer to Standard OP1 OP3 Good Practice Recommendations The registered persons should consider providing documents in a format that would benefit service users with dementia. The registered persons should incorporate in the assessment of service users with Dementia – their existing abilities with regard to ordinary activities of daily life and life histories. The registered persons should ensure risk assessments are DS0000015586.V295412.R01.S.doc Version 5.2 Page 38 3 OP2 Chaseview Care Centre 4 4 5 6 7 OP8 OP16 OP19 OP22 OP31 dated once reviewed – even if there are no changes. The registered persons should develop a system for identifying and safeguarding personal items such as dentures, spectacles and hearing aids. The registered persons should consider producing complaints in a format that could be understood by service users with Dementia. The registered persons should ensure that appropriate contingency arrangements are in place when the home’s equipment fail. The registered persons should review the call alarm system currently in use – given the perceived difficulty in acquiring replacement parts for it. The registered persons should review the effectiveness of the communication systems between the team and management, particularly in the absence of a deputy. Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 39 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 © 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 Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 40 Chaseview Care Centre DS0000015586.V295412.R01.S.doc Version 5.2 Page 41 - 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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