Inspection on 25/01/07 for Chaseview Care Centre

This inspection was carried out on 25th January 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chaseview Care Centre 17/05/06

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 09:55 25th January to 2nd February 2007 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.V328853.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.V328853.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) Jonathan Hoyle 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.V328853.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2006 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, en-suite, 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 service users have access to generic garden spaces. 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.V328853.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 second key inspection within the inspection year 2006/07 and all the key standards were assessed as well as most of the nonkey standards. The inspection started on the 25/1/07 and concluded on the 2/2/07 with feedback to the registered and operations managers. The inspection found that there were several improvements made since the last visit, which was supported by comments received from staff, service users and their relatives, as they relayed their experiences in relation to using Chaseview. The key to the improvements was that there was greater consistency in the service provision across the three units; Ford (Dementia), Harts (Residential) and, Nicholas and Kennedy (Nursing). It was clear that although improvements are still required – that service users were experiencing a better quality of life in the home. On Ford Unit (Dementia) for example, improvements to training, activities, the innovative use of communal spaces, signage and décor means that the home is now more able to meet the assessed needs of service users living with dementia. However, it is important that the progress made on the environment and activities continues with even more improvements. The registered provider took action in what could only be described as key areas in achieving their improvements. One such area was reviewing the management of the home. To this end they appointed a registered manager and recruited a deputy manager to lead the changes that were required. There was clear evidence that staff were involved and motivated as they went about their duties and this had positive outcomes for the service as a whole. One of the comments noted about the new manager was: “He has given us all a morale boost and made us focus on what we are all here for, which is to give good care to people”. Due to the illness and mental capacity of the service users it was difficult to have meaningful discussions with some service users spoken to on Ford House, as to their views of the home and care being received. However, the atmosphere on this unit was calm and none of the service users were being rushed. With regard to the care being provided to service users living with dementia, the inspectors were satisfied that this was good in relation to their health care needs. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 6 The inspection included discussions with the senior persons in charge of each unit, detailed discussions with the deputy manager, interviews with staff, discussions with ancillary staff and a visiting GP, conversations with service users and visitors to the home and an assessment of records to include: staffing recruitment and training records, rotas, 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: At Chaseview service users still benefit from receiving support in a structured way, despite the home being a 120-bedded facility. The divisions of two nursing, one dementia and one residential unit, each with thirty beds, ensures that service users needs are streamlined into a smaller units. In this way care and support is provided with minimum disruption even if the needs of service users change. Service users are also able to get to know staff and given their limited verbal communication skills – this is quite important to them. The home remained bright and airy was in a better state of repair. Service users continue to 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. They have access to communal spaces both indoors and outdoors, including the use of two sensory gardens, which are pleasant. Memory boxes were now on the walls outside some bedrooms particularly on Ford and this had a positive impact on the homeliness of the environment. Service users continue to benefit from improvements to the assessment system process and service user planning was generally good. Further improvements were required and the organisation had plans to introduce a new system known as ‘QUEST’ with a view to enhancing service user planning in the home. The service continued to maintain professional relationships with external agencies to ensuring that the health and welfare needs of service users are adequately provided for. Some of the key links maintained included; the tissue viability nurse, speech and language therapist, the diabetic nurse, and, St. Francis Hospice in relation to palliative care. The organisation also utilises the expertise of their tissue viability specialist, who is involved in reviewing, monitoring and advising on maters relating to the management of good pressure care. Service users and their relatives described more pleasant experiences with the staff in respecting their values and wishes. Feedback received confirmed that staff worked hard to provide a good service at Chaseview. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 7 The registered persons worked in a positive manner with the Commission in bringing about improvements to the experiences of service users living in the home. What has improved since the last inspection? The statement of purpose and service user guide now complies with the Care Homes Regulations 2001 as required in the last inspection report. The fee components were being finalised at the time of drafting this report. Satisfactory arrangements are now in place for all service users to have a copy of their statement of their terms and conditions at Chaseview. This includes service users that are funded by the local authority. Service user plans in Harts house were reflective of their healthcare needs and end-of–life plans were in place for some service users across the home. This was discussed with staff on the nursing units in relation to developing them further. Plans were in place to introduce the Liverpool Care Pathway Model for the ‘Dying Patient’, which involves transferring the hospice model of care into other settings such as, care homes. There was greater evidence that the assessed needs of service uses across the home were more appropriately met, although this could be enhanced through increased efforts around recording and monitoring of the care provided. Significant improvements were made on Ford in that the needs of service users were reviewed thoroughly to ensure that they were appropriately placed on that unit. There was also some improvements noted in the handling of medication in that handwritten entries were signed off and dated by the person and in most cases the source was identifiable. Variable doses were appropriately recorded when given. Some improvement is still however required in this area. Routines and activities were also now more flexible, particularly in the areas identified such as the Ford Unit and, the staff supporting service users with meals had appropriate training to so do. There was also a greater staffing presence during mealtimes at the home and a selection of meals has also been produced in a pictorial format. These are being used to enable people living dementia to make choices as to the menu. Food storage had improved in the home. Feedback from relatives and an assessment of the complaints record indicated that complaints were handled more robustly, inspiring more confidence in the home’s procedures. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 8 There have been significant changes to the environment as a whole, as a programme of redecoration and upgrading the facilities had been undertaken. This included carpet cleaning and replacements and, the ‘dressing’ and personalisation of bedrooms. Arrangements were in place to rectify the bedrooms without carpets. Call alarm systems were also in place for all service users. The environment is much more conducive to creating a more homely feel, and memory boxes have been introduced outside some of the bedrooms. This enabled some service users to identify their bedrooms much more easily and are also points of interest for them when walking down the corridors. Toilets were also more appropriately marked for the benefit of service users, particularly those with Dementia. The quiet lounge on Ford has been fitted with some sensory equipment (and this area is used on a regular basis by many of the service users, under staff supervision. Some of the sensory equipment is mobile and can be taken to service users, choosing to remain in their bedrooms. The atmosphere on this unit (FORD) was much calmer and generally service users appeared well groomed. Staff were observed to be interacting with individuals in a more positive way and this obviously helped to enhance the well-being of service users. The registered persons provided training for staff that was appropriate to the needs of service users and this included areas such as; wound management, palliative care, certificated dementia care training and promoting equality. This had a positive impact on both the staffing motivation and their morale, from which service users now benefit. It was noted at the time of the inspection there was a buzz of activity with regard to training, as both off duty and staff on duty were attending training. What they could do better: It would be of great benefit to service users with Dementia that the home provides information in formats best suited to them. Service user plans on Kennedy need to reflect the changing needs of service users and in so doing be kept updated at all times. Ensure that all monitoring charts e.g. fluid balance, are accurately maintained at all times. Improve the handling of medication by recording and dating the sources of handwritten instructions and changes, and ensuring that all drugs used in the home are accounted for. Arrange a multidisciplinary review to ensure that the involvement of the relative of (Mrs P) is safe and in her best interests. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 9 Provide more small tables for service users on Ford House to enable them to safely have their meals. Keep the staffing levels under review to ensure that adequate numbers are on duty particularly at peak times, bank holidays and weekends. This includes also ensuring that adequate arrangements are made to provide staffing cover. Apart from the service user numbers, staffing levels must take into consideration the dependency levels of service users. Continue with the installation of memory boxes outside all of the bedrooms, improvements to the environment on Ford and, continue with the compilation of life histories for each resident so that these can be used in one to one activities by staff. These will also help staff to engage with service users on a more individual basis. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 10 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.V328853.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (1,2,3,4,6) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user now benefit from having updated information about the services provided by Chaseview. They also benefit from having a statement of their terms and conditions, outlining their obligations, and that of the organisation. Detailed and full assessments are carried out to ensure that service users are appropriately admitted to the home and this helps to provide assurances that their needs would be met. Standard 6 does not apply to this home, as intermediate care is not provided in the home. EVIDENCE: Service users had access to updated information about the services provided at Chaseview. One of the most recently admitted individuals on Harts House informed that she found the information provided in both the service user’s guide and the statement of purpose, useful in enabling her to make a decision about coming to live there. Service users are now clearer on the types of services provided, including support for individuals with dementia, as well as the arrangements for the provision of palliative care in the home. Some work Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 12 is still required to produce the documents in a format suitable for service users with Dementia. It was noted that the statement of purpose was detailed and contained the current organisational structure. The fee components and charges for services were being finalised at the time of drafting this report and the inspectors viewed this information during feedback to the registered persons. The home is therefore compliant with the regulations relating to both documents and this is positive. As part of case tracking, fifteen service users’ files were assessed across the four units and it was observed that a statement of terms and conditions were made available to individuals now, as a matter of routine. Adequate arrangements were in place to ensure that service users funded by the local authority had the benefit of a copy of the local authority’s contract setting out clearly the obligations of the parties concerned. Service users and their relatives are therefore now clearer and more confident with regards to the contractual arrangements around individual placements at Chaseview. Individual records are kept for each service user and a number of files were examined on the nursing, residential and Dementia units. All records inspected have assessment information recorded. The information had been used to continue assessments following admission to the home, and to develop written service user plans. This provided the platform for meeting the needs of service users. The records showed that service users where capable, and their relatives are involved in the assessment process. It was noted in the Dementia unit that more detail is now given to obtaining information around a person’s existing abilities with regard to ordinary activities of daily life and life histories. This is now being incorporated into the service user plans to enable the staff to provide the right level of care in both health and social areas. As a result the home was able to demonstrate that the needs of service users were generally well provided for. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (7,8,9,10,11) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements in care practices, service user planning and support with medication ensures that service users are in receipt of a higher standard of care at Chaseview. They also benefit from having their end–of-life wishes recorded and carried out. Their respect and dignity is promoted at all levels throughout the home. However, some improvements are required in relation to service user planning, medication and monitoring charts to further enhance the quality of care provided in the home. EVIDENCE: Service user plans were in place for all individuals living in the home and further improvements were noted in their quality. From case tracking, some of the important improvements included; the inclusion of healthcare needs on both Harts and Ford units, as well as the social and cultural an end-of-life needs across all units. The registered manager has expressed an interest in implementing the Liverpool Care Pathway (LCP) for the Dying Patient. This transfers the hospice model of care into other settings and has been used effectively in care homes. This should enhance the quality of care for service users in the end stages of their life. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 14 Service user plans were reviewed monthly and more reflective of service users’ needs. It was also noted that service users or their relatives sign this document as part of their involvement in the process. There has been the introduction of a ‘resident of the day’ audit, which is aimed at ensuring that service users plans are updated and reflective of service users’ needs. This should have a positive outcome for service users with regards to the overall quality of care delivered to them. However, it was noted that on Kennedy House service user plans required further development to ensure that they provide staff with up to date information about service user’s care, to ensure that care needs are being understood and met on a daily basis. They must be kept updated to reflect the changing needs of service users. On Kennedy, nutrition and weight was recorded in a number of different sources in the service user plan. This could pose some difficulty in accessing and understanding the information by staff that may be unfamiliar with the service user. Despite this, it was noted that the plans for wound management were good, with advice and input being sought from the tissue viability nurse. Additionally and On Ford (Dementia), service user plans could indicate the different methods of communication for each individual such as facial expressions, different words and their meanings for the individual. Individual staff members will have gained this knowledge through the delivery of care to individual service users, and the sharing of such information would further enhance the care to people living with dementia. The home was better able to demonstrate that it was meeting the assessed needs of service users across all units at this inspection. Generally service users are weighed monthly and where there are concerns, such as weight loss or not eating, weights are monitored weekly with referrals made to appropriate health care professionals. Risk assessments were also in place for all service users and examples included; falls, pressure sore prevention, continence, the use of cot sides, manual handling and, for service users who are prone to “walking”. Body maps are also completed following an accident or incident and, accident forms are completed. From the records viewed, which included wound management; catheter care; diabetes; and the management of infection, the inspectors gathered that in most cases, they were quite detailed. It was also clear service users are seen by other health professionals such as tissue viability nurse and diabetic nurse specialists; speech and language therapist; optical, dental and chiropody services. Whilst on Harts (residential) a service user was on her way to the Moorfield Eye Hospital for her eyes. The district nurse was also regularly involved in relation to her ulcer. In speaking with the individual, she expressed satisfaction with the support she received in relation to her healthcare. Other service users spoken to, were also complimentary about the care they received Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 15 and comments included “I’m happy with the care, I have everything I need”. Monitoring charts including blood sugar, food wastage, repositioning and fluid intake/output, were also examined and most were maintained to a good standard. However, a number of fluid balance charts across the nursing and dementia units needed to be maintained appropriately. They were found either inaccurately or retrospectively filled out. On Nicholas, for example at 13.45 hours on the day of the visit there were only two recorded entries on the chart for one individual i.e. 09.00 and 11.00 hrs. If the recordings of fluid intake are indicated for a service user, then this must be considered to be a clinical record and must be monitored by nursing staff accordingly. Some staff were recording fluids on the food wastage charts, but not on the fluid charts. It is essential that all monitoring records are maintained accurately and up to date. Discussions with staff and observation on the day would suggest that service users were receiving adequate fluids but that staff were failing to record this on each occasion. Similarly, food wastage charts were maintained where necessary, however, staff must record the amount of food intake as well as the type of food. For example, entries included “porridge, soup, sandwich”. The amount of food taken by the service user must be clearly recorded for example, two tablespoons; large bowl; size and number of sandwiches. The detail of this recording will ensure that an accurate record is being maintained of nutrition. In another case a service user with an in-dwelling catheter was required to have bladder washouts every seventy hours, but there was no record of this either in the service user plan or the Medication Administration Chart (MAR). This needs to improve. There were some improvements in the handling of medication across the home and clear medication policies and procedures were in place for staff to follow. On the nursing units, only the nurses are responsible for giving medication however, all staff responsible for medication had appropriate training to so do. There was evidence that a medication audit is carried out monthly. A review of the medication records showed that the policies and procedures were being followed and the inspectors were generally satisfied that service users were safeguarded with regard to their medication. It was observed that where possible service users were encouraged to manage their medication and this was evident on Harts (Residential). Appropriate assessments were in place to ensure that any risks to service users were kept to a minimum. This is positive as it helps to promote service user independence. Some improvements are still required in managing medication, primarily on the nursing and residential units. They included: 1) ensuring that the source of handwritten instructions are recorded (raised at the last inspection), 2) ensuring that medication that is crossed out is initialled and Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 16 preferably dated and 3) ensuring an accurate account of drugs used is maintained at all times (Harts). Staff were observed to treating service users with kindness and respect throughout the home. They were seen to be offering explanations and reassurance when undertaking moving and handling tasks, exhibiting patience and due care when interacting with them. The arrangements for their personal care ensure that their right to privacy is upheld. Staff are now making sure that aids, such as dentures, spectacles and hearing aids, are marked with the name or initial of the service user. This is also quite important in ensuring that service users dignity is upheld. Greater efforts have been put into ensuring that service users wishes regarding terminal care, and arrangements after death were assessed and recorded. Relatives and service users were generally involved in this process, as were other professionals e.g. the GP. This would be further enhanced if the registered persons pursued the Liverpool Care Pathway model referred to earlier in this report. Service users are now more assured that they would be supported to live their life in a home knowing that they could see their last days there, as well as having their wishes carried out, following death. . Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (12,13,14,15) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy a full range of activities and are afforded choices that match their lifestyle. They are encouraged to maintain their networks and benefit from having their nutritional needs adequately provided for at Chaseview. EVIDENCE: Despite it being an unannounced inspection, there was a buzz of activity throughout the home and it was clear that most individuals were effectively engaged. A programme of activities was is place, and on the day of the inspection a quiz was being held on Harts (residential). However, a team from each of the houses was present, and staff were seen taking service users from Ford House and the nursing units over to the quiz. Activities are now more individual or small group focused, and the addition of the sensory equipment on Ford House appears to have had a very positive effect. An interview with the activity coordinator indicated that every service user has an opportunity to engage in activities, including individuals in their rooms. Some of the person centred activities included; the use of talking books, aromatherapy and pampering. One service user indicated that she enjoys being pampered and made up and quite look forward to this. A risk assessment is carried out on activities and there is a sense of innovation in relation to engaging service users in activities. One example is the use of a dog from ‘Pets Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 18 at Therapy’ – a registered charity, that comes in once per week and service users get to stroke the dog. An employment network is also used to acquire volunteers, for befriending lonely service users. Appropriate checks and training e.g. fire and manual handling are carried out. Service users were quite pleased with team sports and a group female service users stated; ‘we regularly beat up the men at bowls’. This has become a positive aspect of the home’s operations. Relatives/friends are encouraged to visit the home and there are no restrictions on when people can visit. Visiting can be undertaken in the lounges or in the privacy of the service user’s room. The inspectors observed members of staff allowing time for service users to express their wishes and supporting individuals to make choices in their daily lives, for example choosing a drink, the type of music to listen to, or where they wished to eat their meal. Service users are encouraged to personalise their bedrooms, with the involvement of their relatives, which is positive. All relatives spoken to confirmed that the visiting times were flexible. One relative stated that staff ‘make her feel welcome at any time’. The registered manager has started hosting ‘relatives and residents’ meetings across all units and this has generated a greater feeling of involvement by all concerned. There has been a significant improvement in the way in which meals are provided in the home and service users now really enjoy a pleasurable experience. On Kennedy House one of the activity co-ordinators was serving a selection of pre-lunch drinks to all residents including, sherry, wine and low or non-alcoholic drinks. This has recently been introduced across all four houses. This helps to stimulate the appetite of service users and is seen as being important in considering the nutritional needs of service users and the overall dining experience. The serving of the lunchtime meal was observed on Kennedy, Harts and Ford units and provided service users with an appealing, varied and nutritious meal. A choice of meals was available to all service users on the day. Service users also chose to eat in the dining room or in their rooms. Staff were seen to offer assistance where necessary and this was done discreetly and individually. Pureed meals were presented in an attractive and appealing manner and service users who required assistance were not hurried. On Ford the majority of the thirty service users need either supervision by staff, or assistance with eating, and staff were observed to be offering assistance appropriately. 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. It was clear that staff received training in, supporting service users with their meals and, they were in adequate numbers to give the support required. Activity coordinators were involved in supporting service users with their meals, but this Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 19 may not be so on weekends and as such this needed to be looked at by management. Most service users had meals at the dining tables, while those wishing to eat in their rooms or away from the dining tables were supported to so do. Wherever possible they were encouraged to eat their meals independently and this was positive to see. More importantly the food was provided in such a way that service users with Dementia, wishing to use their hands were able to enjoy both their independence and the meal provided. The registered persons could take credit for giving consideration to promoting the independence of service users as far as feasibly possible. During a visit to the kitchen, the inspector was able to speak to the chef who had a good knowledge of the service users’ needs, and he was aware of any special dietary needs. Fresh fruit and vegetables are available on a regular basis and much of the food is freshly cooked on the premises. A light night menu is also available and generally it is Ford and Hart House that orders snacks. There are generally no requests from the two nursing units. Service users were happy with the meal arrangements in the home. Chaseview Care Centre DS0000015586.V328853.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. JUDGEMENT – we looked at outcomes for the following standard(s): (16,18) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives are assured that their complaints would be looked into. Adult Protection strategies are in place to ensure that service users remain safe while at Chaseview. Action needs to be taken in one case to ensure greater safety for the individual referred to in the body of the report. EVIDENCE: The inspectors were able to speak to several relatives who felt, confident that they knew who to complain to, and that they would be listened to. Service users were also aware as to how to complain if they were unhappy with their care. There was a reduction in the complaints since the change in management, but more importantly all complaints were looked at an investigated – thoroughly. Evidence was provided of this, prior to and during the inspection. This is positive for all concerned. An adult protection procedure was in place and was available to staff. The organisation has provided adult protection training for staff and this has boosted their confidence in dealing with allegations and/or suspicions of abuse. From the discussions held with staff, they were aware of the action to be taken if there were concerns about the welfare and safety of service users. The home did have adult protection issues raised since the last inspection an appropriate actions had been taken to protect service users, living in the home. The number of adult protection issues in the home had generally declined. The GP when asked if she had any concerns in relation to abuse in the home responded by saying: “no, not at this home”. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 21 However, the registered manager need to take steps by calling a multidisciplinary review to ensure that the actions taken by one relative do not put his relation at risk. The relative concerned clearly wishes to be involved in the care of his wife and this is generally allowed. His actions are contrary to the professional advice in managing the service user’s healthcare and her moving and handling risk assessment. The service user is diabetic and cutting her toenails is contra-indicated by the visiting chiropodist’s advice. Against the advice, he cuts her toenails. The service user’s manual handling risk assessment also indicates that she is to be moved using a hoist, assisted by two carers. The relative’s desire for the service user to retain her independence with regard to her mobility, means that he sometimes pulls her up and encourages her to take a few steps. This exposes the service user to unnecessary risks and it was reported that staff have raised their concerns with the individual, but he continues with the unsafe practices. The inspectors’ concerns were discussed fully with the registered manager who is required to arrange a multidisciplinary review involving the service user and her husband, to determine a safe and satisfactory way forward. Chaseview Care Centre DS0000015586.V328853.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. JUDGEMENT – we looked at outcomes for the following standard(s): (19,20,21,22,24,25,26,) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users now enjoy an environment that is well maintained and adapted to meet their needs. This includes their personal spaces, which were personalised. There is a range of equipment, furnishings and facilities that not only makes the environment homely, but stimulating and safe for service users living there. Service users on Ford would benefit from having more small tables for their use during mealtimes and the registered persons could explore a introducing a system for monitoring the response times, when the call alarms are activated. EVIDENCE: The inspectors toured all areas of the home and were satisfied that a number of significant improvements were made. The external grounds were in good condition and on the day, gardeners were observed carrying out maintenance. One service user from Harts enjoys walking around the grounds and was observed happily making her way out during the course of the inspection. Service users now benefit from enjoying some gardening experience with the activity coordinators. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 23 The layout of the lounges on Kennedy and Nicholas has been changed and small grouped seating areas have been created. The standard of the décor, furnishings and fittings were generally maintained to a good standard. On Ford some carpets have been replaced, and bedrooms showed evidence of being clean and personalised. Where some bedrooms did not have carpets, arrangements are in place for this to be rectified. Memory boxes adorned the walls outside bedrooms on Ford and this added quite a special feature to the environment. Service users now have objects they could identify and refer in their home. This is positive and needs to continue. Cleanliness and hygiene was of a good standard and there were no offensive odours in the home. On Harts, the environment was stimulating and service users were seen enjoying both their personal and communal spaces. The small quiet lounge on Ford is now more regularly used by service users and also contains the sensory equipment, which appears to have been beneficial to many of the individuals using it. Doorframes have also been painted red on this unit and the home used the advice of Dementia consultant in its re-design. Consideration should still be given to the location of the television in the large lounge on Ford unit. This is still located high on a wall, and service users were seated, almost under this. These service users had no means of moving to a quieter area, and for others the location of the television could cause problems with their necks. This should be looked at with the assistance of an occupational therapist. There was evidence that call alarms were accessible and available to all service users and this is an improvement since the last inspection. It would be useful if a system for monitoring response times is installed to monitor the length of time service users have to wait. Relatives spoken to were happier with the fact that their loved ones had access to facilities to signal for help if and when they needed it. It was also noted that grab rails, hoists and other equipment were accessible and available to service users. The storage of hoists was more strategic, as they did not clog up the bathrooms and corridors. Bathrooms and toilets were clean, accessible and equipped to meet the needs of service users. They were also equipped to promote the privacy of service users and in the residential unit, service users were observed independently using them. The toilets and baths were equipped to promote service users independence and service users spoken to, confirmed this. During a visit to the kitchen and laundry, both areas were maintained to a good standard. Food was appropriately labelled and stored and all of the kitchen equipment was in good working order. The laundry staff were aware of when to use protective equipment and hazardous substances were being appropriately stored, and all equipment was in good working order. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 24 Housekeeping staff are now undertaking small repairs such as the sewing on of buttons, or the repair to hems and seams. In discussions with the head housekeeper it was apparent that there had been many improvements at the home. Cleaning equipment was now available in sufficient quantities, and more hours have been allocated which has enabled the regular deep cleaning of carpets. Vacant rooms have now been redecorated, and are now “dressed” so that they are welcoming and attractive for prospective service users. The cleaning of the satellite kitchens on each House is now the responsibility of the housekeeping staff and they too were maintained to a good standard. However, the registered persons would need to purchase more small tables for those individuals particularly on Ford who wish to have their meals away from the table. The current use of trays on the laps of staff is too risky. There must be sufficient small tables for service users needing to use them. This point was raised by a relative who said “there really do need to be more small tables, I or my sister come in daily to help feed my mum, and I always insist on having a table, but I can see that there aren’t enough”. Lighting, heating and ventilation was of a good standard and most of the service users spoken informed that they were comfortable in the home. There was a complaint about the cooling systems in the home during the hot summer weather last year and steps were taken by the registered persons to rectify this. Given the time of the inspection, the effectiveness of the systems could not be adequately tested. The registered persons however, reassured that service users were made comfortable during the hot weather. Water temperatures were being monitored and hot water temperatures were consistent in maintaining the safety of service users in home. The laundry equipment was adequate for meeting the needs of service users and was in good working order. Hand washing facilities are prominently sited throughout the home and staff were observed to be practising an adequate standard of hand hygiene. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (27,28,29,30) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive a good standard of care from a staff team that is motivated, committed and provided with specialised training to carry out their jobs. Generally staffing numbers are appropriate to meet the needs of the service user group, although this must be reviewed to ensure that adequate numbers are on duty at all times, across all areas of the home. The organisation’s recruitment processes act as a good safeguard to protecting vulnerable service users. EVIDENCE: Staffing levels and the skill mix of qualified nurses and care staff on Nicholas, Kennedy and Ford Houses were sufficient to meet the assessed nursing and personal care needs of the service users. A similar conclusion was drawn from Harts House in that the levels and skill mix were adequate to meet the needs of the service users living there. Effective team working was observed and evidenced throughout the inspection and on all areas. Staff interacted well, both with each other and the service users. They also appeared much more relaxed and motivated and all the individuals spoken to, said they felt that the new manager was very approachable, operated an open door policy and, that they enjoyed coming to work. In addition to qualified nurses and care staff, the home employs activity coordinators, catering, laundry, domestic, maintenance and administrative staff. This eases up the pressure on care staff from having to perform ancillary tasks and the activity coordinators do get involved in areas such as assisting with meals. This is an area that has improved particularly on Ford, but from Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 26 assessing the rota, there would be problems on weekends and holidays. Relatives have contacted the Commission about this prior to the inspection and gave examples of low staffing levels over the Christmas period. The registered manager stated that nursing staff are also expected to be actively engaging with service users, outside of their clinical duties. In discussion with the nurses on the two nursing units, it was apparent that staffing levels are based on the numbers of service users and not necessarily based on the assessed dependency needs of service users. Relatives spoken to on Kennedy House expressed their concerns around staffing levels. They were not critical of the care staff as individuals however, they commented that sometimes the lounge is left unattended and staff do not always have just to sit and talk to service users. On Harts, the roster for the 12/01/07 showed that two staff members were off sick, but only one was replaced, because of availability. Staff indicated that the bank pool is limited and the organisation does not employ agency staff, so staff are drawn from other areas to help out. While most of the staff cooperate it puts a strain on the areas from which the staff are removed. This needs reviewing to ensure that adequate arrangements are in place to cover staffing absence and meeting the needs of service users at all times. It was positive to see that the staffing ratios on the residential unit remain the same generally, on weekends. The inspectors concluded that while the staffing arrangements were better than previously across several areas, they needed reviewing to ensure that; they adequately meet the assessed and dependency levels of service users at all times, including holidays and weekends. There was evidence to confirm that over fifty per cent of the care staff had achieved their NVQ Level 2 Award in Care. Arrangements were also in place to ensure that other staff have the opportunity to pursue this qualification. Service users are therefore supported by staff- the majority of who have a good understanding of care. From observation and discussions held with care staff, they demonstrated an understanding of the needs of the service user group and, the aims and objectives of the service. This is positive as an outcome for service users. A random sample of the staffing personnel files was viewed and it was evident that the organisation’s recruitment processes are robust. Evidence was found that references are taken up and, criminal records bureau disclosures are obtained for staff. An initial check is also made against the Protection of Vulnerable Adults list. Appropriate checks are also made on the Nursing and Midwifery Council’s register to ensure the validity of the registration of the nursing staff employed in the home. Service users are therefore assured that staff working with them, are thoroughly vetted before being employed by the organisation. As a result, service users are relatively safe at Chaseview. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 27 There has been a significant improvement in the training provided for all levels of staff working in the home, both in terms of volume and the quality, which was specific to service users’ needs. This was apparent even during the course of the inspection, as staff showed enthusiasm turning up for training on the day. Some of the training provided included; Certificated Dementia Care, Nutrition and Feeding, Catheter and Incontinence training, Palliative Care and the use of Syringe Drivers, Promoting Equality, NVQ level 2 training, Care Planning, Adult Protection and mandatory training to include Fire, Food Hygiene and, Health and Safety. On Ford House, the senior sister undertook an intensive training course in the care of people living with dementia and is endeavouring to cascade this down to care staff. Time is being allowed for this cascade training to ensure that it is effective and beneficial to staff, from which service users stand to benefit. Care staff are now being 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, are now undertaking comprehensive and certificated training in caring for people living with dementia. This is positive. The impact of training has been positive on the staffing morale and confidence. In this respect service users stand to benefit as a whole. While of Ford House, it was possible to speak to a visiting GP, and she was very complimentary around the staff team and the care that is being given on this unit. She said; “Genny is excellent, she knows all of the residents and if I ask her any questions when visiting a particular resident, she can always give me the answers.” She also said; “one gentleman came into this home with really swollen legs, but with the care that he has received there has been a drastic reduction to the swellings.” The inspectors were satisfied that the standard and quality of staff training made a positive difference in staffing competence and knowledge and hence, the overall quality of care provided in the home. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (31,32,33,34,35,36,37,38) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A change in management and improvements to the management systems in the home, have ensured that service users are receiving a higher standard of care at Chaseview. Quality monitoring in the home has improved, as well as health and safety practices. Supervisory and support arrangements for staff ensure that they are focussed on delivering good quality care. Service users are able to access their personal records, which were generally updated, apart from various monitoring charts. EVIDENCE: A experienced and suitably qualified manager is now in place at the home and since his arrival in October 2006, he has set about getting staff motivated and involved in driving up standards in the home. He is quite knowledgeable with regards to the needs of the service user group and makes appropriate links to ensure that he is up to speed with developments in relation to the care of the elderly. He is ably assisted by the head of care and between them, clear Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 29 systems and procedures are in place to ensure that service users receive good quality care. One of the improvements noted is the approach to promoting equality and diversity in the home particularly amongst the staff team. One way of achieving this was to ensure that staff had training in ‘Promoting Equality’ and this training is consolidated by ensuring that staff are aware of the organisation’s equal opportunities policy and that they work within it. The impact of this is that staff morale is much higher and they are more confident in letting their feelings known and contributing to the overall operations of the home. There was a great feeling of teamwork that filtered throughout all levels of staff, including those working on the Dementia Unit. Positive action was also taken by re-issuing the whistle blowing policy to all units and by increasing the equal opportunities monitoring of the service. This was carried out in the main by, the operations manager and the human resources department. The direction and leadership of the service, is held in, high esteem by service users, relatives and all staff. The current management structure is more compact, in that the senior team is now made up of the manager, deputy, and the four heads of units. Staff reported that all layers of management are more accessible and that an open door policy now operates at the home. The deputy manager moves across the services on a daily basis and ensures that guidance, support and training is appropriately provided to staff. When speaking to staff about the new management and working relationships within the home, a member of staff said; “it is as if a black cloud has been lifted and the sun is beginning to shine through.” In speaking with other staff during the visit, both care and departmental staff spoke very positively about the new manager and his open and inclusive style of management. One member of staff said: “He has given us all a morale boost and made us focus on what we are all here for, which is to give good care to people”. Another said: “His door is always open – if we have a problem we know we can speak to him”. It was clear that staff were on a level that they felt empowered by the managerial changes. They were also aware of their responsibilities in relation to the GSCC code of conduct. This is a strong area of then homes operations. Sound arrangements were in place for the monitoring the quality of service provision in the home. Monthly provider visits are carried out frequently and the registered manager and his deputy carry quality audits of the service. One example is ‘a resident of the day’ audit, which looks at the care planning and meeting the care needs of service users. Reviews were also regularly held for service users. It was noted that service users and their relatives are now more Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 30 involved in the home and evidence of meetings held, were presented as evidence of this. The organisation carries out its quality assurance checks annually and staff have access to professional advice from e.g. the organisation’s tissue viability specialist. This would is useful to ensuring good standards of practice in the home. It was noted that there has also been regular input from the operations manager in terms of monitoring and supporting the changes required by the previous inspection report. Service users quality surveys and an annual development plan were not requested at this visit, but would be looked at, in the next inspection. The Inspectors were satisfied that the financial interests of service users are safeguarded by the robust financial policies and procedures. 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. Adequate insurance arrangements were in place at the home and there were records of all financial transactions, available for inspection. There were adequate arrangements in place for the supervision of all staff with care staff having more frequent sessions as required by the national minimum standards. Records viewed indicated that supervision covered all aspects of care practice, the philosophy of care and career development. Discussions with staff informed that they were happy with the support they received in supervision and most felt that their personal and professional needs were met. There were arrangements to ensure that volunteers receive training that is appropriate, so that their contributions to the service do not put service users at risk. Most of the records viewed were maintained in a satisfactory manner. There are clear guidelines in place detailing how service users and their relatives, could access their (service user’s) personal records. As stated earlier in this report, improvements are required in relation to how monitoring charts are maintained and this is an area that the organisation needs to tighten up on. The reasons being that they are extremely important aspects of service user’s care and concerns were identified previously in this area. Records throughout the home are maintained in a secure manner and in line with statutory requirements. There were improvements in relation to health and safety practices in the home. One of the key improvements was the decreased incidence of fire doors being wedged open. Risk awareness and fire safety training had been provided and the registered manager confirmed that, during the course of his rounds, he took action whenever a fire door was found wedged. It was felt that wedging fire doors became custom and practice – one that needed direct and constant action to eliminate it. Service users are now generally safer in the home. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 31 All maintenance records, including equipment such as hoists and wheelchairs, fire safety, lift maintenance and water temperature checks, were viewed and found to be up to date and in good order. Safety signs were appropriately posted throughout the home and a clear system is in place to ensure that maintenance books are completed in a timely manner across all units. The maintenance staff initials on a daily basis, entries logged in these books. Records of all accidents/incidents were in place at the home. Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 32 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 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 3 X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 3 3 3 3 3 Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 15/04/07 2. OP8 12,13 3. OP9 12,13 4. OP18 13 5. OP20 16 & 23 (1)(a) The registered persons are required to ensure that service user plans (Kennedy) reflect the changing needs of service users and are kept updated at all times. The registered persons are 15/04/07 required to ensure that all monitoring charts are accurately maintained throughout the home. The registered persons are 15/04/07 required to ensure that: 1) the source of handwritten medication instructions are recorded, 2) that medication, ‘crossed out’ is initialled and preferably dated and 3) an accurate account of drugs used, is maintained at all times (Harts). The registered manager is 15/04/07 required to arrange a multidisciplinary review for SU (Mrs P). Also see standard 18. The registered persons are 30/04/07 required to provide small tables on Ford House for the benefit of service users, eating away from the dining table. DS0000015586.V328853.R01.S.doc Version 5.2 Page 34 Chaseview Care Centre 6. OP27 18(1)(a) The registered persons are 15/04/07 required to keep under review the staffing levels to ensure that: adequate staff are on duty at peak times e.g. mealtimes, bank holidays, and weekends and, to ensure that appropriate arrangements are made to cover staffing absence at all times (See Standard 27). This forms part of a previously made requirement with a timescale 31/07/06. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 OP16 2. OP7 Good Practice Recommendations The registered persons should consider providing documents in a format that would benefit service users with dementia. This should include the complaints procedure. The registered persons should include facial expressions and other individual communication cues used by individuals in their service users plans. This is particularly useful in the Dementia Unit. The registered persons should relocate the wall- mounted TV on Ford to a more comfortable location that most benefits the service users wishing to use it. The registered persons should consider introducing a system for monitoring response times to the call alarms. The registered persons should consider increasing its bank pool of staff to improve the possibility of obtaining cover, when needed. 4. 5. 6. OP19 OP22 OP27 Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chaseview Care Centre DS0000015586.V328853.R01.S.doc Version 5.2 Page 36 - 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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