Inspection on 11/05/06 for Chasewood

This inspection was carried out on 11th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chasewood 02/06/09

Chasewood 09/12/08

Chasewood 08/05/08

Chasewood 08/11/07

Chasewood 15/06/07

Chasewood 07/12/06

Chasewood 01/02/06

Chasewood 05/05/05

Chasewood 06/01/05

Chasewood 18/06/04

Similar services:

Maple Lodge

Heathlands

Breme

Ravenhurst

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Chasewood 39 School Lane Exhall Coventry West Midlands CV7 9GE Lead Inspector Yvette Delaney Key Unannounced Inspection 11th 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 Chasewood DS0000004216.V295774.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. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chasewood Address 39 School Lane Exhall Coventry West Midlands CV7 9GE 02476 738211 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) Chasewood Care Ltd Mrs Catherine Tranter Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered manager must work at least 3 days a week supernumerary to the care rota in order to complete management tasks. 1st February 2006 Date of last inspection Brief Description of the Service: Chasewood is a converted, detached property, set back from the road and providing accommodation on two floors. The home is registered to provide care for 22 elderly residents with dementia. The ground floor of the home provides accommodation for fourteen residents. There is a large open-plan communal area at the centre of the ground floor, and leading off from this area are three wings providing bedrooms, a kitchen, laundry and the managers office. There is a further lounge with a conservatory leading into the garden. Ten single bedrooms are provided for residents at ground floor level, and two shared rooms. There is a shaft lift to the first floor, as well as the stairs, where accommodation is provided for eight residents. Facilities provided on this floor are a lounge, dining room (with a kitchenette), and six bedrooms, two of which are shared rooms. There are two separate lavatories at this level, a bathroom and a shower room. On the ground floor french windows lead onto the rear garden, and the home has a small patio area to the rear of the property. To the front of the home there is parking space for about six cars. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection for this inspection year 2006/07 and was carried out by two inspectors. Two senior carers were available for most of the inspection. The deputy manager arrived once informed and was available until approximately 2 pm. The owner of the home was present at various times throughout the day and was available at the completion of the inspection for the feedback. The inspection visit was unannounced and took place between the hours of 09.30 am and 8 pm. The Pharmacist Inspector for the Commission carried out a random inspection on 13 March 2006. The visit resulted in a letter of serious concern being issued. The requirements from that inspection have been included in this report. Records relating to resident care, staff training and recruitment, supervision of staff and health and safety were examined. A tour of the home was undertaken and included visiting bedrooms and communal areas. Nine residents were spoken with; five relatives were seen during this visit. Seven care staff were also spoken with. The registered manager and registered provider were both available throughout the inspection. A service questionnaire was completed by the home and returned to the Commission for Social Care Inspection (CSCI) prior to this inspection. The manager was asked to distribute other questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the views that people who live in the home or experience the service through visiting the home may have. The Commission at the time of writing this report had not received any responses from residents or visitors/relatives. One relative spoken to was unaware of the questionnaires and staff were unaware as to whether any questionnaires had been completed. What the service does well: The attitude of the staff toward the residents is good and staff were seen talking to the residents at different times during the day. A resident indicated she was generally satisfied with the service she receives. Comments include ‘the staff are all very good’. A number of resident’s rooms have been personalised. The relatives of one resident have decorated their bedroom, which was bright, warm and homely. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality of this outcome group is adequate this judgement has been made using available evidence including a visit to the home. Residents’ needs are not suitably assessed prior to admission to the home and therefore residents and relatives cannot be assured that their needs will be met. EVIDENCE: Four care profiles were examined and residents seen. It was noted in all of the profiles that pre-admission assessments carried out by senior care staff were incomplete and as a result the type of care planned and given did not always address the needs of residents. An example of this was demonstrated in one of the care plans examined. The initial assessment for a resident admitted for short-term care had not been updated to reflect the residents’ current admission and care needs. As the assessment of individual care needs is poor, the residents and their families cannot be assured that all their needs will be met. In three of the care profiles there were social services care management assessments. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10 Standard 9 examined by the Pharmacist inspector 13/03/06 The quality of this outcome group is poor this judgement has been made using available evidence including a visit to the home. Resident’s health, personal and social care needs are not set out in individual care plans, resulting in the omission of appropriate care and putting residents at risk. EVIDENCE: Four care plans were examined it was found that they lacked information to fully identify the current care needs of these residents. One resident spoke very little English. Care plans did not provide any details on the residents’ level of understanding and did not identify the best methods to use to communicate with this person. The care plan stated that the residents’ weight was steady this was based on the recording of one weight. There was no other evidence of a weight record, which would show variation in weight loss or gain. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 10 This resident also liked to walk and was at risk of falls and wandering outside of the home. There was no cross-referencing of assessments in care plans and an action plan was not in place to ensure consistency of approach and care provision by care staff. At least four other residents were observed to like walking constantly around the home. Similar findings were observed for the second of the four residents case tracked in that the nutrition assessment said that the residents weight was steady based on one weight recording. It was also recorded that this resident is also at risk of ‘absconding’ a care plan had not been developed to demonstrate how staff should manage this situation if the resident were to leave the building alone or go missing from the home. Another resident case tracked at this inspection has high dependency needs requiring assistance with personal care, feeding, mobility and transferring. The social services management team carried out an initial assessment related to mobility and transfer prior to the residents’ admission to the home. Equipment provided to help meet this residents needs include hoists, special nursing bed with bedrails, pressure relieving mattress and a pressure relieving cushion. A parker bath is also available to help meet some of the personal care needs. Due to risk of pressure area damage instructions were for the resident to use a special cushion when sitting on a chair. A cushion was not being used although the resident was sitting in the lounge during the inspection. The risk assessment related to moving and handling for this resident had not been updated. The care plan available states: ‘Mobility 2 carers using wheelchair, transfers.’ There are no instructions for staff to use the hoist and no further information related to moving and the mobility of this resident. There were two hoists seen in this resident’s bedroom. Staff were unable to confirm why this was and whether both hoists are used for the resident. A nutrition assessment was available and a care plan written to demonstrate how staff were to meet the residents needs. The care plan identified that the resident needs help to cut up food and a drink can be placed in their hand. Observation at mealtime identified that a carer was feeding the resident. The carer was attentive but there was no attempt to encourage or support the resident in feeding themselves. The carer said that this was because the resident gets ‘into a mess.’ If the resident’s needs had changed and they were unable to feed themselves this was not reflected in a review of care needs or identified in the care plan. The care profiles for a further resident recently re-admitted for a period of respite care did not evidence that staff at the home had carried out an updated re-assessment of the resident’s care needs. The care management team had also not re-assessed this residents needs. The resident looked unwell, was not eating well and had a poor appetite. There were no care plans completed for this resident, which includes no nutritional risk assessment or care plan on how staff should meet the residents nutritional needs. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 11 Dietary likes and dislikes were not recorded and records were not maintained of what and how much food and fluids the resident was eating and drinking. The poor management of the nutritional needs of this resident could result in serious harm due to malnutrition and dehydration. Written details were maintained in one of the care plans following a visit by the district nursing services due to concerns related to pressure area care. There is one recording where a visit was requested from a Locum GP due to resident looking unwell. Staff have recorded ‘Locum doctor said not to waste their time.’ There is no information to demonstrate how this incident was handled and the Commission was not notified that this problem had occurred. The acting manager at a previous inspection had expressed concerns that the doctor was reluctant to visit for routine check ups and when residents were reported as unwell. An inspection carried out on the 13 March 2006 by the pharmacist inspector identified concerns with medication procedures carried out in the home. This visit resulted in a letter of serious concern being issued. The requirements from the inspection have been brought forward into this report. One visitor spoken with said that she felt her relative was well presented and their personal care needs were being met. To promote privacy, a security lock is fitted to the door of residents’ rooms. Two residents who were able to communicate effectively said that they are cared for and that they felt that the staff respect their privacy. Some residents looked well groomed while others wore clothes that were creased and poorly maintained for instance, buttons were missing from cardigans and the hem of a resident’s dress was hanging down. One resident was wearing a cardigan underneath her dress and a number of residents were not wearing stockings or tights, indicating individual care needs were not being met. A resident indicated she was generally satisfied with the service she receives. Further comments from residents include ‘the staff are all very good’. Residents have access to a communal phone and all residents can use the office phone for private calls if they wish. During a tour of the premises it was noted that although privacy screens were provided in double rooms the location of the washbasin, mean residents do not have their privacy protected when attending to their personal care needs. Care workers were observed, closing the doors to residents’ rooms before undertaking personal care tasks. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 12 Two further visitors spoken with said the resident they visit generally looks well presented. They were unable to comment on the quality of care received by their relative as she has poor short-term memory and were unable to comment on her experiences. Four care staff spoken with said residents were well cared for, and their privacy and dignity respected. The staff also reported that consultation with healthcare professionals, or treatments are carried out in the privacy of the resident’s own room. Two residents spoken with said the staff were respectful and confirmed consultations with GPs or district nurses take place in private. Observations during a tour of the premises found that a window in a toilet on the ground floor did not have obscure glass or privacy curtains fitted. Therefore, resident’s privacy and dignity may be compromised. Only one resident had been given the key to their private room. The outcome of assessments or other written information was not available to explain why other residents were not provided with keys to their own bedrooms. This was of particular relevance as a number of bedrooms were kept locked preventing residents from accessing their own bedrooms. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The quality of this outcome group is adequate this judgement has been made using available evidence including a visit to the home. Resident’s daily lifestyle in the home related to meals and stimulation demonstrates a lack of understanding of the therapeutic and emotional needs of residents with dementia. EVIDENCE: On the day of the visit there was no evidence of planned activities taking place. The home does not employ an activities organiser, preferring instead to delegate responsibility to the care workers. One resident spoken with, said she was able to attend a church service and enjoyed ‘spending time in the garden, weather permitting’. Another resident said ‘bingo was sometimes arranged, but there were no other activities or regular trips out’. The home does not have a structured activities programme, and details of any activities taking place are not displayed. Staff spoken with said they advise residents of any activities taking place. Staff spoken with had some understanding of the individual needs of residents requiring specialist dementia care, but they were not all fully aware of the range of activities that may be of particular benefit to people with dementia. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 14 Individual life history ’s had been written for some residents these were not comprehensive and would not support planning care or stimulation for residents. One senior carer spoken to said ‘activities often take place in the afternoon, when the staff bring their own CDs in and encourage residents to sing along to the music’. A music and movement exercise takes place and a musician visits the home to entertain residents. Visits to the Civic Hall also take place. One resident said she can choose how to spend her time and was able to retire and get up when she liked. When asked about the arrangements for bathing one resident said ‘a bath rota is held in a bath book and they tell us when its our turn’. Such practices are considered institutional and should be discouraged in favour of a more flexible approach that takes into account the individual needs and aspirations of residents. Residents and visitors spoken with said visiting was flexible and visitors are made to feel welcome. Meals are served in three areas of the home, a lounge/dining area on the ground floor and a lounge or kitchenette on the first floor. Most residents sat at the dining tables, apart from teatime upstairs, when residents had their tea served in the lounge. Hot drinks were served to residents throughout the duration of the visit. Fresh fruit was readily available in the home. Discussion with the cook found that choices available to residents include a cooked breakfast, which is the preferred choice of most residents. At the time of the visit none of the residents had been assessed as requiring a specialist diet. The care staff prepare the teatime meal after the cook has gone home. Three residents spoken with confirm they have a cooked breakfast, which they all said they all enjoyed. Mealtimes were not particularly well managed and the intervals between meals not always taken into consideration. For example one resident who had not eaten since teatime the previous day did not have breakfast served until 11:45am and was then served lunch 35 minutes later at 12:20pm. In order to ensure residents, nutritional needs are met; food must be made readily available at regular intervals. One resident was observed to be asleep in lounge at lunchtime. The resident did not eat any lunch and staff were not seen to encourage or support them with eating until teatime when the resident was transferred to their bedroom. At teatime residents on the first floor were given bread, butter and crisps, followed by sponge cake. Faggots were on the menu but were only initially offered to residents on the ground floor. One resident complained to the staff about the absence of a suitable alternative. A care worker eventually responded and prepared a sandwich of the resident’s choosing. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 15 One resident with dementia did not receive the support she needed to manage her food. The resident, confused by the appearance of the food in front of her, ate crisps and sponge cake together. Greater effort is required by the staff, to ensure all residents receive the individual care and support they need to manage their food. One care worker was observed assisting a resident to eat her food. Support was provided in a sensitive manner and at a pace conducive to the resident’s needs. At lunchtime, residents were served braised steak or pasties, mixed vegetables and mashed potatoes, followed by sponge and custard. Three staff spoken to say, they inform residents of any alternatives and ask which dish they would prefer. Details of individual preferences are given to the cook before the food is prepared. Two residents spoken with couldnt remember which dish theyd chosen for their lunch. Meals were plated up by the staff and were generally well presented. There is no formal system in place that enables consultation with the residents about menu planning. The cook has responsibility for ordering provisions and for planning the menus, which are usually devised a few days in advance. Records of some of the food provided for residents was held, but this information was not sufficiently detailed to determine whether or not the diet is satisfactory, in relation to nutrition. It was observed that those residents unable to make informed choices had their meals chosen by the staff. Staff were not heard or seen to offer or support residents in making a choice. Those residents spoken with who were able to express a view said the food was generally good. Comments noted also include ‘we get fed up with sandwiches at tea time’. The most recent visit by an Environmental Health Officer (EHO) took place in March 2006. A number of areas were identified as requiring attention and were yet to be addressed, including cleaning the kitchen ceiling. The kitchen and food storage areas are small but appear suitable for purpose. Food opened or prepared was dated before being stored in the fridge or freezer. Records of fridge, freezer and cooked high-risk foods were held and maintained. A cleaning schedule was in place and cleaning products stored in a designated area. Food storage areas were well stocked and held a range of provisions and fresh fruit. Discussion with the cook evidence basic food hygiene training has been undertaken and updates made available. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality outcome for this group is adequate this judgement is made using available evidence including a visit to the home. Complaints and concerns are investigated but the lack of ongoing training for staff related to adult protection does not ensure that resident’s rights and protection from abuse are fully protected. This may result in decreasing their feeling of safety and quality of life in the home. EVIDENCE: The home has a procedure for handling complaints this needs to be reviewed to ensure that all the information detailed in the document is accurate. Staff were able to demonstrate through discussion how they would deal with any complaint received in the home. The procedure is available and accessible to residents, staff and visitors in the home. A copy of the procedure was displayed in the front foyer of the home. A discussion with a relative at the time of inspection said that her complaints were listened to and her concerns addressed after taking her concerns to the Registered Manager for the sister home of Chasewood. The Commission has not received any complaints about the home since the last inspection. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 17 Care plan records and discussions with a relative demonstrate that resident’s rights are protected through the support of their relatives. Information on how to access professional advocacy services is not displayed in the home. The home has policies and procedures for the protection of vulnerable adults. Discussions with the acting manager for the home demonstrate that there has been no incident requiring referral to protection of vulnerable adult procedures. Training records examined do not clearly demonstrate that staff have attended recent adult protection training sessions. Conversations with staff demonstrate that they were unable to demonstrate an adequate knowledge of local procedures for responding to allegations of abuse. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24 and 26 The quality outcome for this group is adequate this judgement is made using available evidence including a visit to the home. The environment is poorly maintained which impacts on the experience of those living in the home. EVIDENCE: A tour of the home identified that there had been very little action carried out to ensure improvements in the day-to-day maintenance of the home. There remained the need to address requirements made in respect of the environment at previous inspection visits. The maintenance man was mowing the lawn on the day of inspection, he works 10 hours per week and was able to provide records of odd jobs carried out in the home. There was no evidence of an ongoing maintenance programme in the home. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 19 Signage and pictures to aid orientation for residents around the home were not used. The gardens present a pleasant area for residents to sit. On the day of inspection it was a pleasant sunny day but the opportunity was not taken until suggested by the inspectors to take residents outside to enjoy the sunshine and fresh air. The general cleanliness of the home is poor and the toilets, shower room and some resident’s bedrooms, required thorough cleaning. There were areas that had unpleasant odours; this was noticed in some bedrooms. The home employs one cleaner who works 20 hours a week. This may not be a sufficient number of hours to provide an acceptable level of cleanliness in the home. There are not enough assisted bathing facilities for the residents. The home has one assisted bath and a shower room; other bathing facilities available are not assisted and are not used, as the residents cannot get in and out of them. A bucket was used in one bathroom to collect water leaking from a pipe under the sink. One toilet was closed and out of use while waiting for repairs to be carried out. The most recent visit by an Environmental Health Officer (EHO) took place in March 2006. A number of areas were identified as requiring attention and were yet to be addressed, including cleaning the kitchen ceiling. Access to the shower room on the first floor of the home did not provide level access for residents and staff to enter the room, presenting a potential hazard. Risk assessments had not been completed and a notice had not been placed in an appropriate place to warn anyone entering the shower room making them aware of the step. The home provides equipment necessary to assist residents to maintain their mobility. A tour of the premises found a residents room was used to store two mechanical hoists. Discussions with a member of staff revealed that the resident uses both hoists but there was no reflection of this in their care plan. Case tracking this resident identified that they would not need the use of two hoists when transferring. Not all resident’s rooms have a mirror and the electric sockets used for shaving are not all appropriately sited. For example one resident has to kneel down to use the wall socket, which was sited behind the door and close to the floor. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 20 A number of resident’s rooms have been personalised. The relatives of one resident have decorated their bedroom, which was bright, warm and homely. A number of other areas in the home including some resident’s bedrooms are shabby and have wallpaper coming off the walls. Furniture supplied by the home was evident in most resident’s bedrooms. Many of the items seen were shabby and worn and required repairing or replacing. For example some residents cannot gain access to their clothes as the doorknobs or handles fitted on wardrobes and drawers are either damaged or missing. Not all residents have a bedside cabinet or a lockable space in which to store personal items. Examination of documentation evidence an inventory is held of all personal items brought into the home. Vinyl flooring remains in some bedrooms, shower room, bathroom and dining areas. Risk assessments have not been completed to determine the level of risk and action to be taken should the floor become slippery when wet. Some improvements were noted in the laundry room, for instance, the room was more organised and clean clothes were either folded or were on coat hangers. Soiled and clean linen was separated and soiled linen washed at appropriate, hot water temperatures. Some residents looked well groomed while others wore clothes that were creased and poorly maintained for instance, buttons were missing from cardigans and the hem of a resident’s dress was hanging down. Two residents spoken with said, the laundry wasnt too bad, they wear their own clothes all the time, but are dissatisfied when their clothes cant be found, as they have to wait for the staff to find the missing garments. Staff have access to disposable gloves and aprons, which they use when carrying out personal care tasks. At the time of the visit, a written policy/procedure for the prevention and control of infection was unavailable for examination. A tour of the premises found a soiled hand towel had been left on the floor of a shower room and a container used by staff to dispose of soiled incontinence pads was without a lid. These practices increase the risk of cross infection. Written guidance for staff on the disposal of clinical waste was available. The document states ‘staff should dispose of pad waste at the earliest opportunity by using the macerator’ this document must be revised to reflect current arrangements for the disposal of incontinence pads as the home does not have a macerator. Three staff spoken with said they had received training on infection control and were aware of the need to wear protective clothing in particular circumstances. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The quality outcome for this group is adequate this judgement is made using available evidence including a visit to the home. There are sufficient care staff to meet the needs of residents but the lack and absence of information related to staff files, recruitment, training and lack of sufficient ancillary staff does not confirm that appropriate support is maintained to ensure the health and safety of residents. EVIDENCE: At the time of the visit the staff team consisted of a deputy manager, five senior carers eleven care staff, two cooks and a cleaner. On duty on the day of the visit were two senior care workers, two carers, a cook and a cleaner. In discussion, the designated senior carer on duty, said the staff were flexible and always provide any additional cover if called upon to do so. Five designated care staff provide care at night. In the absence of the deputy manager, a designated senior carer takes responsibility for the management of the home. A duty rota identifies the names of the staff, how they are to be deployed and the role of the worker. Staff rotas also evidence the home covers any staff absence with their own staff. Two residents and three visitors spoken with said there always appeared to be sufficient numbers of staff on duty. Four staff spoken with confirmed that the number of care staff on duty at any given time were sufficient to meet the individual needs of the residents. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 22 The home employs one cleaner who works twenty hours a week. This may not be a sufficient number of hours to provide an acceptable level of cleanliness in the home. Staff rotas did not identify the arrangements for providing cover in the absence of the cleaner. The home also lacks a designated laundry person, which if appointed may improve standards and would provide greater accountability. Discussion with the staff and examination of documentation confirm seven staff have either obtained a National Vocational Qualification (NVQ) level two or three, or are working towards achieving the Award. Three staff spoken with were enthusiastic about training. One care worker said the range and opportunities for attending training was ‘ wonderful’. Discussion with the senior carer evidence that most staff have completed dementia care training, and all have undertaken training in moving and handling, basic food hygiene and first aid. Three care workers spoken to confirmed attendance at a dementia care training course, moving and handling and basic food hygiene training. One care worker said she had undertaken training on managing challenging behaviours. The home takes advantage of free training offered to carers, provided by the learning and development centre. The next course is on ‘continence awareness and pressure ulcer prevention’. Information about training and development given by the staff could not be confirmed, as staff training records were not available for examination. Only two of the three staff files selected for examination could be located. The two files examined held no evidence of staff training and development. Both staff files held a staff induction checklist but only one was completed. The staff recruitment records and files of two staff examined, identified a number of shortfalls in the staff recruitment process. • • • • No evidence of gaps in employment history being explored. Two written references not held on one of the two files. No recent photograph. Medical disclosure not completed on one of the two files. Enhanced Criminal Record Bureau (CRB’s) disclosure certificates were held in for only eight of the 19 staff employed at the home. A further seven CRB’s were held of staff that were no longer employed. CRBs or PoVA first checks were not available for 11 staff working directly with residents. Two staff spoken with said they had undertaken a staff induction. Videotapes are used to provide initial training in the prevention of abuse and lifting and handling. Staff are then entered onto the next available external training course on abuse and attend an internal course for lifting and handling training. Staff spoken to confirm this occurred. Records held do not include the name of any mentor or details of any supervision that may have occurred. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 The quality outcome for this group is adequate this judgement is made using available evidence including a visit to the home. There are a number of areas related to the homes management and operation which needs to be improved to ensure the safety of residents at all times and an increase in their self-worth and quality of life. EVIDENCE: The Deputy Manager currently manages the home in the absence of an appointed registered manager. There was evidence that the deputy does not feel that she would like to take on the post of Registered manager and is perhaps not yet ready for this role. The Inspectors was informed that adverts have been placed to recruit a permanent manager. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 24 There are a number of areas related to the homes management and operation, which need to be improved to ensure the safety of residents at all times: • • • • Management systems in the home were not organised, some information required at the time of inspection was not readily available these include a staff file and procedures. Assessments and care plans had not been updated to reflect resident’s current needs. Staff files examined showed evidence of poor recruitment procedures. Clear records were not available to demonstrate training and induction of staff. Action had not yet been taken to address requirements made at the last inspection related to the cleanliness of the environment and the condition of furniture and furnishing provided for residents. Evidence was not available to confirm that a structured approach to quality assurance had been implemented. The deputy manager does not routinely carry out audit of systems and practices carried out in the home. Written reports which detail the outcome of monthly unannounced visits to the home were not available and the Commission has not received copies of these. In discussion, the senior carer said that she was only aware of one resident managing their own finances, while family members support most residents. The senior carer was unaware of whether independent professional advocates support any residents with managing their finances. Information on how to access professional advocacy services is not displayed in the home. Monies are held by the home on behalf of a number of residents for safekeeping and are stored safely and securely. Residents’ money is held separately in individual plastic wallets. Records are held of all financial transactions, but individual receipts are not always held in respect of money spent on behalf of the resident. For example a receipt supporting £10.00 spent on shopping was not held therefore practices are unsafe. Individual records are held of all financial transactions and records maintained in accordance with the Data Protection Act 1998. Of the four care workers spoken with two said they had received one-to-one supervision. There was no documentary evidence available to support the view that regular one-to-one supervision occurred. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 25 There has been a lack of notification to the Commission of accidents and incidents that have occurred in the home. Accident records examined identify that there have been ten accidents recorded since the last inspection visit these show a pattern of falls and involve items of furniture. Two of the accidents recorded should have been notified to the Commission. There were some service and contract records that could be found for examination, those not available to confirm ongoing maintenance checks include fire safety, attendance at fire drills, emergency lighting and water temperatures and legionella testing. Resident aids and equipment have current service records, this includes hoists and assisted baths. There was no evidence of an ongoing maintenance programme in the home. The maintenance man was mowing the lawns on the day of inspection; he was able to provide records of odd jobs carried out in the home. The Registration Certificate was not displayed in the home and the owner was unable to find the Certificate. A valid and current insurance liability certificate is displayed in the home. Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 2 X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 2 Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14, Sch.3 Requirement The registered provider/manager must ensure that a full preadmission assessment is carried out on all prospective residents to ensure that their needs can be met; this must include residents admitted for respite care. The registered provider/manager must ensure that the resident and/or their representative receive information confirming that their assessed needs can be met by the home. (Outstanding from July O5) The registered provider/manager must ensure that care plans are written and implemented for all residents accommodated in the home. The registered provider/manager must ensure that the care plans reflect all the care needs of the residents, are evaluated monthly and give clear and concise guidance to the staff. Timescale for action 31/08/06 2 OP4 14 31/08/06 3 OP7 15 31/08/06 4 OP7 15 31/08/06 Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 28 5 OP7 15 The registered provider/manager must ensure that the resident and/or their representative are involved in the care planning process where possible. The registered provider/manager must ensure that all residents are weighed and monitored more frequently where there is evidence of weight loss. A full nutrition assessment must also be completed and a care plan developed which describes the actions to be taken to minimise the risk to health and well being of individual residents. The registered provider/manager must ensure that risk assessments are completed for all residents. Where a risk is determined a care plan must be devised describing the actions to be taken to minimise the risk. Particular attention must be given to: • Mobility • Transfers • Falls • Nutrition. Policies and procedures for good medicine management must be written in line with the Royal Pharmaceutical Society of Great Britain’s guidelines (as referred to in Standard 9.4). All staff must be trained to adhere to the policies and procedures written to ensure that all medicines are administered as the doctor prescribed and in a safe manner. The right medicine must be administered to the right service user at the right dose and the right time and records must reflect practice. DS0000004216.V295774.R01.S.doc 31/08/06 6 OP8 14, 17 31/08/06 7 OP8 12, 13(4) Sch.3 31/08/06 8 OP9 13(2) 12/05/06 9 OP9 13(2) 12/05/06 10 OP9 13(2) 12/05/06 Chasewood Version 5.2 Page 29 11 OP9 13(2) 12 OP9 13(2) The Medicine Administration Record (MAR) chart must be referred to before the medicine administration and the transaction recorded accurately directly afterwards. The reasons for non-administration must be recorded. The MAR chart must record the exact dose as the doctor intended to ensure that all service users are administered their medicines as prescribed. The purchase of a Controlled Drug cabinet is required that complies with the Misuse of Drugs (safe custody) 1973 and fixed to a permanent wall in a room where the temperature does not rise above 25ºC. The purchase of a medicine trolley is required to safely transport the medicine to the service users during the medicine round. All prescriptions must be seen prior to dispensing, checked and a system installed to ensure that the dispensed medicines and MAR chart are checked against the prescription for accuracy upon receipt, before any administration takes place. A doctor must support any dose changes in writing. Staff drug audits must be undertaken before and after a drug round to confirm that staff are correctly administering medicines and the records reflect practice. All medicines must be labelled in accordance with the Labelling Regulations 1976 (as amended) and returned to the pharmacist if they are not. DS0000004216.V295774.R01.S.doc 12/05/06 12/05/06 13 OP9 13(2) 12/05/06 14 OP9 13(2) 12/05/06 15 OP9 13(2) 12/05/06 16 17 OP9 OP9 13(2) 13(2) 12/05/06 12/05/06 18 OP9 13(2) 12/05/06 Chasewood Version 5.2 Page 30 19 OP9 13(2) Medicines that are no longer required must be returned to the pharmacist for destruction and not kept on the premise for use at a later date. The registered provider/manager must ensure that the care home is conducted in a manner which respects the privacy and dignity of residents: • Care staff must ensure that residents are suitably dressed at all times. • Care staff must be able to demonstrate how they protect the privacy and dignity when attending to the personal care needs of residents who have to share a bedroom. 12/05/06 20 OP10 12(4)(a) 31/08/06 • 21 OP12 16 The communal toilet window must be obscured to protect the privacy of residents when using this facility. The registered provider/manager must ensure that opportunities for stimulation is provided through leisure and recreational activities both in and outside the home. Activities must reflect the needs and abilities of individual residents. The registered provider/manager must ensure be able to demonstrate: • How residents are consulted about their social interests. • The arrangements in place to enable residents to engage in local, social and community activities. • How residents are consulted about any programme of arranged activities. 31/08/06 22 OP12 16 31/08/06 Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 31 23 OP15 12 24 OP15 16(2)(i) 25 OP16 22(1)(6) Sch.4(11) 18(1)(c) 26 OP18 The registered provider/manager must ensure that it is clearly recorded in residents profiles the actions to be taken by staff when a resident refuses or misses a meal. The action taken and outcome must also be recorded. The registered provider/manager must ensure the provision of suitable, wholesome and nutritious food, which are properly presented, and available at reasonable times to meet the individual needs of residents. The registered provider/manager must ensure that the Complaints Policy and Procedure contains accurate information. The registered provider/manager must ensure that all staff attend up to date training in adult protection and records are available to confirm attendance. 30/06/06 31/08/06 31/08/06 31/08/06 27 OP19 13, 23 28 OP21 23(2) The registered provider/manager 30/06/06 must undertake environmental risk assessments so as to ensure that all areas of the home are safe for the residents and staff to use. This must include a review of the vinyl flooring used in rooms throughout the home. The registered provider/manager 30/06/06 must ensure that sufficient numbers of lavatories, baths and shower facilities are suitably adapted and accessible to meet the needs of residents. This must include: • Ensuring safe access to the shower room on the first floor of the home. Appropriate action must be taken based on the outcome of the risk assessment. Version 5.2 Page 32 Chasewood DS0000004216.V295774.R01.S.doc 29 OP22 23(2) 30 OP22 23 31 OP24 23, 16 32 OP26 12, 16 33 OP29 19, Sch.2 The registered provider/manager must ensure that suitable provision is made for storage: • Communal equipment and hoists must not be stored in resident’s bedrooms. Suitable storage space must be available for hoists. The registered provider/manager must ensure that residents bedrooms are suitably adapted to meet their individual needs in a way that decreases risks to their health and safety: • Bedrooms must be reviewed to ensure that mirrors and electrical sockets are suitably placed when used for shaving. The registered provider/manager must ensure that all furnishings in the residents own rooms are in good repair and suitable for use: (Outstanding from July O5) • The damaged furniture in bedrooms needs to be replaced. • Door snobs and handles need to be replaced on wardrobes and chest of drawers • The registered provider must supply a locked facility for the individual use of each resident. The registered provider/manager must ensure that the home is clean and free from offensive odours. (Outstanding from July O5) The registered provider/manager must ensure that recruitment procedures in the home must be reviewed to ensure a robust and consistent approach to staff recruitment and employment practices, which evidences that staff are safe to work with vulnerable adults. DS0000004216.V295774.R01.S.doc 31/08/06 30/06/06 31/08/06 31/07/06 31/07/06 Chasewood Version 5.2 Page 33 34 OP30 18(1)(c) 35 OP31 8(1)(a) 36 OP31 10 37 OP33 24, 26 The registered provider/manager must ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform: • Evidence must be available which confirms that all staff are up to date in mandatory training requirements. • The registered person must supply details of all training undertaken by staff to evidence their competence and should supply the training plan to the current year. The registered provider must forward an application to the Commission requesting the registration of a manager for the home. The registered provider/manager must be able to demonstrate what management systems are in place to ensure the suitable running and management of the home. The registered provider/manager must ensure that a suitable system is established for reviewing and improving the quality of care, provided in the home. The outcome of these must be shared with the Commission and reports available for inspection. The registered provider/manager must make unannounced visits to the care home at least monthly to monitor the standard of care provided, inspect the premises, records of events and any complaints. A report on the conduct of the home must be prepared and a copy forwarded to the Commission. 31/08/06 31/08/06 31/08/06 30/09/06 38 OP33 26 31/07/06 Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 34 39 OP35 9(a) 40 OP36 18(2) 41 OP38 CSA Pt II, Sec.28(1) 42 OP38 37 43 OP38 17, Sch.3, Sch.4 The registered provider/manager must maintain records of the purpose for which residents’ money was used and retain receipts for items or services purchased on behalf of the resident. The registered provider/manager must ensure that all persons working at the care home are appropriately supervised. Clear and informative records must be maintained and available for inspection. The registered provider/manager must ensure that the Certificate of Registration is displayed in an accessible area of the home as stated in the Care Standards Act Part II, Section 28 (1) The registered provider/manager must ensure that notification is forwarded to the Commission of any event/s that effects the well being of residents as outlined in Regulation 37. To include failure to secure the services of a GP for residents considered unwell. The registered provider/manager must ensure that records, which demonstrate safe working practices in the home, are easily accessible and maintained in the home for inspection. 31/07/06 31/08/06 30/06/06 31/07/06 31/07/06 Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 35 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 OP10 Good Practice Recommendations All residents should be offered a key to their bedroom, unless there are clear reasons for not doing so. Details of any restrictions should be recorded in the individual’s care plan. Resident’s interests should be recorded and used to formulate activities. Activities should be expanded to include the use of items for promoting mental agility or encourage finer dexterity skills. Individual life history’s should be further developed and transferred to the care profile for daily use. A menu offering a choice of meals should be made available to residents. Picture images should be used to offer choices to residents with dementia. The registered manager should produce a programme of routine maintenance and evidence of renewal of the fabric and decoration of the premises. Signage and pictures should also be used to aid orientation around the home. The information held on the staff rota should be expanded to identify the arrangements for providing cover in the absence of the cleaner. Staffing arrangements should be reviewed so as to increase the number of designated hours spent on cleaning tasks. The appointment of a designated laundry person should improve and maintain the standard of residents clothing and would provide greater accountability. Information on how to access professional independent advocacy services should be displayed in the home. 2 3 4 5 6 7 8 9 OP12 OP12 OP12 OP15 OP19 OP22 OP27 OP27 10 11 OP27 OP35 Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Chasewood DS0000004216.V295774.R01.S.doc Version 5.2 Page 37 - 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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