Inspection on 15/06/07 for Chasewood

This inspection was carried out on 15th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 07/12/06

Chasewood 11/05/06

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 Jackie Howe Key Unannounced Inspection 15th June 2007 09:20 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.V343529.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.V343529.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 Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places Chasewood DS0000004216.V343529.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. 7th December 2006 Date of last inspection Brief Description of the Service: Chasewood is a converted, detached property, providing accommodation on two floors. The home is set back from the road and to the front of the home there is parking space for about six cars. The home is registered to provide care for 22 elderly residents with a 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. Information about the home is available in an information booklet provided in the entrance of the home. The manager has advised on 6th June 2007 that the current fees for a place in the home is £408 per week. Other additional charges include the hairdresser, chiropody, personal toiletries, newspapers and magazines. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection of the inspection year 2007/08 and was unannounced. The main inspection was undertaken over a period of one day, and was carried out between the hours of 09:20 am and 17:00 pm by two inspectors. The pharmacist inspector also visited the home on another day, to inspect the systems for safe storage and administration of medication. Comments and findings from each of the inspectors have been included in this report. The inspection focused on the outcome for residents of life in the home. The manager supplied the commission with a Pre inspection Questionnaire (PIQ). Information from this has been used to make judgements about the service, and have been included in this report. A number of survey questionnaires to be completed by residents and relatives were sent to the home, but none were returned. The inspection process reviews the home’s ability to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision where improvements may be required. During the inspection, the care of three residents was examined in detail, this included speaking with them, reading assessments, care plans and other documentation, observing care offered to them and assessing that staff have the necessary skills to care for them. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. Records including staff files, policies and procedures, health and safety / environmental checks and risk assessments were also read. The new manager was present through out the day, and the manager of the ‘sister’ home and owner also attended the inspection for some time. Inspectors were able to tour the home, and spend time speaking with residents, relatives and staff. One inspector ate lunch with the residents, and was able to observe care practices, and how staff interacted with residents in the home. The inspectors would like to thank the manager, staff and residents for their co-operation and hospitality. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Some improvements have been made generally to the service provision, and a number of requirements from the last inspection have been met. As the home has been without a permanent manager for the majority of this time this is a positive outcome. There is now a new manager in post who is experienced in care provision and management. She is aware that there are still a number of improvements needed to ensure that the home is meeting the standards required, but demonstrated an understanding of what is required. Pre admission assessments show some signs of improvement and information has been received from social services care management assessments. The home has worked hard to improve the medicine management since the last pharmacist inspection in February 2007. However further improvements are needed to ensure that all the medicines are administered as prescribed and that records reflect practice in all instances to safeguard the people who live in the home. Care plans read show that some areas identified for improvement at the last inspection, have been achieved. Some language used in care plans was sensitive and showed some understanding of the very specific needs of people with a dementia. More improvement is required to show in detail how a person likes their personal care to be given, and what they are still able to do for themselves and where appropriate, examples of positive risk taking. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 7 Systems for the safe keeping of residents’ personal monies has improved. Records are now kept and receipts for all transactions obtained. Some signage has been introduced to aid orientation and pictures are on some bathrooms and bedrooms. Recognition that training is required for staff has been acted upon and a number of staff from the home are now booked on an all day training sessions to cover key mandatory areas. 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. The summary of this inspection report can Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 6 Quality in this outcome area is adequate. Information is available about the home, but this may not be easily accessible by all residents and their representatives. Prospective residents are assessed prior to entering the home, so that the home can make assurances that their needs can be met. The home does not offer intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home displays an ‘Information book’ in the entrance hall of the home for prospective residents and their representatives to read, to inform them of the services that the home offers. This book is detailed and includes photographs of the home and its rooms and the managers and owner of the home. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 11 As said the book is rather detailed, and the print is normal sized and may not be easily accessible to some prospective residents and their representatives. The manager was not aware if this was available in alternative formats and should develop this further for residents and their families who may require larger font, more signs and pictures or simpler language. The date of when the book was last reviewed should also be included so that interested parties are aware of it being up to date. The new manager was unaware of the contracts issued to residents regarding their rights and responsibilities, but said that they could be held at the sister home. She is hoping to start a new file for each resident containing the paperwork, copies of contracts and for general correspondence. Currently prospective residents are informed verbally that a place at the home is available and that the home can meet their needs The relative of one of the residents was spoken with. She had not chosen the home as the placement was arranged as an emergency by a social worker, but she said that she was happy with the home, the staff and the care provided and only had minor concerns. The pre admission assessments for two residents recently admitted to the home were read. The assessments showed that the home had looked at the specific needs of the residents, and had undertaken an assessment in the key risk areas of: nutrition, safety, risk of falls and tissue viability. As the home is specifically offering care to residents with a diagnosis of dementia, the home also undertakes some assessment of the specific needs related to their diagnosis. One of the residents had presented as having some ‘challenging behaviour’ and this had been identified. One of the assessments had not been dated, and additional information had been added following admission. It is important that information obtained is always dated so that a full review to demonstrate improvement or a deterioration in health, can be undertaken. One assessment seen showed that the resident’s cultural and dietary needs related to his religion, had been considered Assessments had also been obtained from social services needs assessments and information about the resident had been received from other health care professionals involved in the care. Care plans had been started for these residents, but did not yet contain sufficient specific information related to personal identified needs, life history information or end of life wishes. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is poor. Care plans have improved, but more detail is required to show that these reflect individual needs, and demonstrate that all health care and social needs are being met. Privacy is respected but the dignity of residents is sometimes compromised by poor practice. Improvements are needed in medication procedures, to ensure that all the medicines are administered as prescribed and records reflect practice in all instances. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for three residents were read as part of the inspection, and their care tracked during the visit to the home. Two of the care plans were for residents recently admitted; the other was for a resident for whom concerns had been raised with the commission. Other care plans were read as part of the pharmacy inspection. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 13 It was evident from the care plans read that some of the areas identified for improvement at the last inspection, had been achieved and staff have gone someway to meeting the requirements made. Language used in care plans was sensitive and showed some understanding of the very specific needs of people with a dementia. Files were reasonably well organised, so that information was more easily located. There is however further need for improvement. Care plans do not fully reflect each person’s individual needs, to ensure that they are receiving care that identifies their retained abilities and is offered in a way they prefer. Plans do not identify in detail how a person likes their personal care to be given, or what they are still able to do for themselves with support from staff and where appropriate, examples of positive risk taking. Care planning regarding nutrition was not well documented in the care plans seen. One resident was identified on assessment as being of ‘low weight and malnourished’. Action required as a result of the assessment, was that a nutritional risk assessment should be completed. No risks were identified from his ‘nutritional assessment’, but the value of this assessment is questionable, as the resident was not weighed. There was little action to be taken by staff recorded in the care plan, no referral to a dietician and his weight was not recorded as an ongoing care plan. One resident in daily records has been given a ‘fortisips’ drink which is a food supplement. There was nothing in the care plan to indicate that this should be given. The inspector was informed that the scales were ‘broken’, but this was disputed by the manager who said that staff had failed to charge the battery. Some records of weights having been taken were evident on a piece of paper pinned on the wall in the office, but not all had been recorded, or transferred to the care plan. Another care plan read showed that risk assessments had been undertaken and there was evidence of a review having taken place with the social worker and a senior carer, and monthly ‘key worker reports’. Some of the daily records read were detailed and gave a good level of information. Others were less so, with references to a resident with nutritional risks, having ‘eaten well’, but without sufficient detail to say what that meant. Records regarding personal hygiene are very irregular. Some baths and showers are recorded, but this is not consistent and for some residents there was no record of them receiving a bath or shower for some weeks. One record showed that a resident had ‘refused’ a bath, but there was nothing to say that this had been re-offered or if the reasons for refusal explored. This is Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 14 particularly important in the provision of dementia care so that staff can offer care in a consistent way. Improvements should also be made in recording activities and social activity linked to individual needs and choices. One care plan had no information for this, although the resident was able to clearly voice his needs and told the inspectors that he felt ‘bored’. Information gained from life history work should be used to develop this part of the care plan. A discussion about the quality of some areas of care planning was held with the new manager who demonstrated a good understanding of where improvements were required and the principles of ‘person centred care planning’. She demonstrated a commitment to improve these further, and the need for staff training in this area. Evidence was available to show that residents are given access to their GP and are supported to attend hospital appointments and receive care from an optician and a chiropodist. The manager said that the home does not currently have access to a dentist and this is of concern to some relatives. Care plans and daily records read as part of the pharmacy inspection, did not always support newly prescribed medication and it could not be found why some people who live in the home had been prescribed some medicines or been to hospital. One relative spoken with said that staff were always ‘on the ball’ and responded to illness and change promptly. The inspector was informed that the resident was always bathed, clean and tidy but was sometimes unshaven. The inspector was also told that residents often are not wearing their own clothes, despite these being available and labelled with the person’s name. This does not show an understanding of personal care and lacks the promotion of dignity. The pharmacist inspection took place on a separate date to the main inspection. Four peoples medicine charts and medication were audited together with two supporting plans. The deputy manager was spoken with throughout the inspection and all feedback was given to her and the new manager. The home has purchased a new trolley and Controlled Drug cabinet and register. Controlled drugs were stored in the cabinet and the balances was reflected in the CD register. Other medicines were also recorded in the CD register that were not Controlled Drugs. Audits indicated that the medicines are not adequately checked in each 28 day cycle. Staff had failed to record all the quantities of medicines received in addition to balances carried over from previous cycles for all new medicines Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 15 received outside the 28 day delivery. Staff had recorded the incorrect reason why some medicines had not been administered and also failed to cross off one medicine that had been discontinued by the doctor. However medicines dispensed in a monitored dosage system supplied by the pharmacist to ease administration had been administered correctly and records mainly supported practice. Problems were seen when new medicines were bought into the home by relatives or following discharge from hospital. Staff had failed to remove duplicate medicines from the medicine trolley and it was difficult to demonstrate whether some medicines had not been administered twice inadvertently. One person continually refused his medication and the manager said that the doctor had been contacted three times to discuss it, once during the inspection. No documented evidence could be found for this communication. Currently only one person is responsible for checking in the medicines each month. The usual care assistant did not check them in this month and the manager had only been working in the home for 2 days. The manager discussed enhanced procedures to stop the same errors occurring again. The deputy manager had a good understanding of the clinical condition of the people who live in the home and what their medication was prescribed for. The home used to operate a quality assurance system to confirm staff administer medicines as prescribed and accurately record the transaction. This had stopped since the previous manager had left and the new manager was keen to restart this. Assurance was given that two members of staff are to check in all medication in future and are to be given protected time to do this. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of the above standards were assessed at this inspection. Quality in this outcome area is adequate. Activities are available, but need to be developed to reflect the individual needs and daily living skills of residents. Food provision could be improved by demonstrating the availability of choice and by improving the environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection there were no specific organised activities taking place, but staff were noted particularly in the afternoon to spend some individual time with residents, playing games and to sit and talk. There is not currently a member of staff employed specifically to organise activities so that the role is currently undertaken by the carers. The new manager said that one member of staff had expressed an interest in this and that she was hoping to develop this role further. Some residents, who are more able, were walking around the home and going outside to either enjoy the gardens, or for a cigarette. Some of these residents spoke about feeling ‘bored’ and could have been involved in something more stimulating and suitable to their needs. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 17 Some of the frailer residents, who are unable to communicate easily or interact with others, were noted to spend a great deal of time with little interaction, apart from when receiving personal care. Music was played off an on during the day, and a television was on part of the day. At one point it was on at the same time as the music, but was later turned off by staff. There is a small activity room off the main lounge on the ground floor, where items for games and activities are held. A new organ has been donated to the home, this is left open in case any of the residents choose to play it, and will be used for organised ‘sing-songs’. Items available include games such as ‘bingo’ and ‘ludo’ musical instruments, playing cards, records and tapes and paints and glitter. Evidence of resident’s artwork was seen, and staff spoken with said that they tried to encourage residents to take part in simple games and activity. Care plans do not currently reflect the recreational needs of residents in the home linked to life history or previous interests, so that staff are lacking direction of how to develop activities for each individual. The home has not had the services of an in house hairdresser for some time, but the manager said that a new one has just been employed. Lunchtime was fairly busy, but staff did not appear rushed, or rush residents with their food. A number of residents required support and prompting, some residents required more intervention than others. It is thought to be good practice in dementia care, for staff to sit with residents and join them for a meal, so that visual prompts can be made in relation to reminding residents how to use cutlery etc. This should be considered by the manager, to ensure that meal times are a more enjoyable event rather than task. There are 2 large tables for residents to sit at, with some residents seated in the lounge eating off their laps or at small tables. The dining tables are serviceable and can be wiped clean. There were no tablecloths, tablemats or napkins, although salt, pepper and vinegar were made available. This makes the dining room feel a little like a canteen, rather than a homely dining room. Residents are not involved in table setting, although one resident did try to help clear the table, but this is not planned into individual care plans. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 18 Drinks offered were orange or lemonade. Residents were given a visual choice, which is good practice, with both being left for one resident who could not make up his mind. Residents who needed it, were assisted by staff at a reasonable pace. Two residents were eating in their armchairs in the lounge and were left with their food, which they were eating with their fingers until later in the day. This was not really appropriate as part of the meal was mushy peas and the food had gone cold and was deposited over their fingers. The home should review the availability of appropriate finger foods so that residents who prefer to eat in this way, can do so with dignity. The inspector ate lunch with some of the residents in the dining room. Meals were brought out pre plated, from a choice that had been made earlier. Portion size was not checked, and no resident was offered a second helping by the staff, despite low weight being recorded as an area of concern in some care plans. The menu on day of the inspection was: Fish chips and mushy peas or cold meat and vegetables. Lemon meringue pie, or fruit and cream. There was no cream or ice cream offered with the pie. There was a board displaying the day’s menu on the wall in the dining room, but this was a little cramped as it also contained other information relating to staff on duty, and was therefore difficult to read. There was no picture menu available to assist with choice. The Cook on duty said that there was always sufficient available should anyone change their mind, and that he would provide alternatives should anyone not like either choice. The cook was seen speaking with a resident who prefers not to eat his meal at lunchtime, and offering a choice for later in the day. One resident said the food was ‘excellent’ another said ‘it is normally awful’. The food was served hot and the pudding was really enjoyed by those at the dining table. Menus are held in the kitchen for a four-week period. They were well balanced and showed that there is variety of choices, but did not show the availability of snack foods. The cook said that he would like to involve residents in menu planning. Tea is often something cooked, but staff can also make sandwiches should someone prefer this. Storage cupboards contain tins of corned beef, salmon spread, salmon etc, but no small cans of beans or soup for easy access to an additional hot snack. The cook said staff could open the large catering sized tins if required. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 19 The cook on duty had only just started in the home and works between this home and the sister home Chasewood Lodge. He said that he would like to work there more consistently to develop the meal provision and service available. He has attained his Basic Food Hygiene certificate in the past, but this was some time ago and requires renewal. The head cook is aware of this and training is being organised. Chasewood DS0000004216.V343529.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): Quality in this outcome area is poor. There is a complaints procedure in place, but record keeping does not demonstrate that complaints have been responded to or listened to. A lack of staff training in protecting and safeguarding adults could put people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy is on display by the front door to the home. The policy has been recently been updated by the company. The new manager is unaware if residents or their families had been given a copy of the policy. A record of complaints received, was not readily available for inspection, but when the complaints folder was eventually found, there were no entries for 2006 and 2007. Two concerns have been raised with the commission about this service since the last inspection. • No care plan was on file for a resident presenting with challenging behaviour or guide for how staff should manage this. Also that care plans had not been reviewed, although risk assessments had been. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 21 • Concerns were raised that the Home has been without a Manager for the last 3 months and there did not seem to be anyone in overall control of the home. Relatives had brought to the staffs attention concerns regarding the health of a resident. Whilst this has been recorded by the staff, it has taken a long time for the doctor to be called out and a dentist had not been available. Issues identified in these concerns were assessed during this inspection, and the outcomes reported in the appropriate area of this report. One of the relatives spoken with said that she had never seen the complaints procedure, but had ‘no reason to complain’. Two residents spoken with, said they speak to staff, the deputy manager and manager when they have concerns. Other residents indicated that they would tell someone if they were not happy. The staff training matrix read during the inspection, shows that not all staff have attended training in the Protection of Vulnerable Adults against Abuse (POVA). There is a programme of training for the forthcoming year now in place and POVA is included. One member of staff spoken with said that she had not attended training in POVA, but was aware of the ‘Whistle blowing’ policy. The new manager said that she was aware that there were gaps in training, and saw ensuring all the staff had attended relevant training, as one of her key objectives for improvement. Chasewood DS0000004216.V343529.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): Standards 19, 20, 21, 24 and 26 Quality in this outcome area is poor. Areas of the home are in need of redecoration and refurbishment to consistently offer residents an environment, which is safe, homely, comfortable and promotes independence and positive risk taking. Infection control procedures in place do not safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was undertaken with the manager. The inspector was able to go into all areas of the home, including personal rooms and all communal areas and the gardens. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 23 On the first floor there is small homely lounge, there is a kitchenette with a dining room. Seven residents use these areas, and one resident advised that they use the dining area as the designated smoking area when no food is being served and everyone has eaten. On the ground floor there is a large lounge a small activity area and a dining room. There is a secure, mature and flat rear garden, and there is a ramp to help access of wheelchairs or to walk down, it is wooden and on the day of the inspection, rather slippery for a resident who was walking down it in his slippers. Several residents were seen to use the garden, for a brief walk but mainly to have a cigarette. Six bedrooms were visited. All rooms have a “Yale” lock but the “snip” had been removed so staff could again access in an emergency. All rooms have a range of furniture normally, divan bed, a wardrobe (some were built-in), flooring varied depending on needs, some were carpeted whilst others were hard. There are still some odours of urine in some rooms. Four residents and one relative spoken with about the rooms said that they were happy with the rooms and believe they have all they need. One said that the curtains had been recently been replaced. Some rooms had been personalised including photos and effects such as trinkets. The furniture was seen in rooms to be old but in most cases still functional. The manager advised that this was the furniture many residents had brought in and therefore they were familiar with it. Some of the chests of draws, bedside cabinets and wardrobes are heavily scratched and worn and an assessment should be made about what needs to be replaced, consulting with the residents and or their representatives. The call system in a bedroom was tested, staff turned it off from a main board in the lounge, which is not good practice, as staff do not have to visit the room and identify the reason for the call. There is no emergency call facility. Staff advised that they would turn it on again if they got to a room and there was an emergency. On the day of the inspection, the temperature was comfortable in the home, but radiators in the residents’ rooms are covered or cannot be accessed so it would be difficult for the residents to alter the temperature independently. Other areas that require improvement in residents rooms include, putting a shade on fluorescent lights, repairing and decorating ceilings where there has been water damage and repairing flooring “linoleum” in an en-suite bathroom to ensure it fits the skirting and can be adequately cleaned. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 24 The toilet and bathing facilities were seen. One bath downstairs has an Oxford seat hoist, but available space to safely assist residents maybe limited when two staff are required. Access is through a slide door that has no lock for privacy. Concerns were raised with the owner and manager regarding poor hand washing and drying facilities, a lack of radiator covers, and that the clinical waste bin contained items of domestic waste and had no lid on it. On the first floor there is a floor-draining shower, which is not draining properly, the manager advised that this is only to be used in exceptional circumstance at present until the gradient is checked and repaired. At present there is no water supply to the shower and the door cannot be opened quickly by the staff if there was an emergency. Some parts of the first floor of the building are not well sign posted and would prove difficult to do so without confusing people. In other areas, particularly on first floor, residents were seen coming and going from their rooms and using the communal areas both up and downstairs. They were clearly familiar with the layout and did not get lost or confused. Residents with a dementia often require prompts to remind themselves of a location and to aid them to find their way around independently. This can be achieved by painting the walls different colours, or providing a picture of something memorable on the wall. The manager should consult with residents on how prompts may be best provided in this home to help individual residents, and this should be recorded in the care plan as part of an approach to promoting independence. The laundry area is of real concern as there was evidence of poor infection control practices and poor hygiene. Soiled items of bedding and clothing are taken to the laundry in yellow clinical waste bags, the staff put on gloves and put their hands inside the clinical waste bag to empty clothing into the washing machine. A member of staff spoken with said that she always wore gloves and an apron, but was not aware of some infection control measures such as using coloured bags to denote soiled or contaminated laundry. The odour from the laundry was offensive. There are two sinks one is a wash hand basin and the other a sluice sink. There were no liquid hand soap or paper towels to wash and dry hands. Both areas were very dirty and the laundry asst said that she never mops this area. There was a mop and mop bucket in the laundry yet the cleaner also confirmed that they do not mop the floor, and that this task is left to the night staff. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 25 There is no dirty in clean out system, clothes, bedding and towels were strewn across shelves, which were covered in lots of dust and were dirty. There were boxes of old shoes, clothing and wheelchair footplates on top of the washing machine. The iron was found inside the box, plugged in but not turned on. This is a potential fire hazard. The washing machine had broken down and would not be seen for repair until three days later. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of the above standards were assessed at this inspection. Quality in this outcome area is poor. Staffing levels in the home meet the needs of the residents, but a lack of training and poor recruitment practices at the home, do not safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a new training plan to be operational between June 2007 and December 2007. The main focus is upon Mandatory training and the programme is shared with the sister home, Chasewood Lodge. The training plan includes POVA, Caring for People with a Dementia, Moving and Handling, Diabetes, Emergency First Aid, Infection Control, Nutrition, Control of Substances Hazardous to Health (COSHH) and Continence Awareness. Although there is a good training plan now in place, the records seen on the training matrix and on individual files for three of the staff, do not demonstrate that staff currently have the required skills to undertake their roles. There are many gaps in mandatory training including first aid, infection control, food hygiene, health and safety, moving and handling and medication. These gaps may well have a poor outcome for residents, as the staff may not give care adequately and safely. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 27 The new manager said that she was aware of the gaps in training and was focusing on those staff to bring them up to date. A number of staff from the home were booked on an all day training session the following week. Some staff were wearing badges showing that they have completed the ‘Yesterday, Today and Tomorrow’ training, which is accredited with the Alzheimer’s society. There are also planned training sessions called ‘Caring for People with a Dementia’ and ‘Behaviours we find difficult’. Four staff files were requested for assessment at the inspection and three were provided. The inspector was informed that one file was at the sister home, Chasewood Lodge, as that was where the member of staff was initially employed. Of the three files checked, only the most recent employee had evidence that a Criminal Record Bureau (CRB) had been undertaken. Two other staff files had no CRB or Protection of Vulnerable Adults (POVA) check on the file provided for inspection. Other omissions noted included lack of health screening, no evidence of interview and no evidence of offer of employment including date to commence. There was also concern that of the three staff only one had two references, and no references could be found for the most recent employee. The recruitment practices at the home do not help safeguard residents and therefore there is increased risk of abuse towards the residents in the home. Relatives spoken with and comments received indicate that the staff group offer a good level of care to residents. ‘The staff are marvellous, I can’t fault them at all’. On the day of the inspection the majority of staff were noted to have a good manner with the residents and offer them care and support in a caring and compassionate way. Some concerns in regard to manner and some training requirements were noted and these were brought to the attention of the manager. Chasewood DS0000004216.V343529.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): Standards 31,33, 35, 36 and 38. Quality in this outcome area is poor. The home has a new manager who is experienced in care provision. Management systems in place, do not demonstrate that the home is being run in the best interests of the residents, nor fully protect their safety, particularly in regard to medication management and control of infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new manager took up her post in May 2007. She has previous management experience of providing domiciliary care services, and in working with people with sensory loss. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 29 She does not have recent experience in working with older people with a dementia, but is aware of person centred care principles, and is keen to undertake more training in dementia care provision. Since starting in the home a few weeks ago, she has spent her time identifying and beginning work on the key areas required for improvement. This has recently involved reassessing the care planning and administration systems in the home. She is aware of what needs to be done and is prioritising these requirements. Systems for the safe keeping of resident’s monies have been reviewed and individual accounts are now in place with receipts available for all transactions made. The staff files for three staff were seen and some records of supervision meetings were read. These were very brief and were not recent and the most newly appointed employee, had not had a meeting since commencing at the home. Supervision meetings are important to monitor the performance of staff and to identify poor practices and need for improvement and training. There is no Quality Assurance system in place at present, but the company has recently employed a consultant to review some of the systems in place. One relative spoken with said that she had never completed a satisfaction survey / questionnaire and was unaware of any meetings taking place in the home although she had attended review meetings. The home employs a ‘handyman’ who is shared with Chasewood Lodge. There is a maintenance book, which is signed when work is completed. This is an improvement and should mean that identified works are dealt with promptly. A Fire risk assessment is available, but this was not signed, not dated, and there was no evidence of review and compliance checks. However there was evidence of good systems for fire evacuation. Records show how each resident would be best supported to leave the building in an emergency. This is good practice. There were regular Fire drills undertaken in 2006, but so far only one in 2007, however records do suggest that all staff have attended two drills in the past 12 months. Fire training is in the form of a Video and Questionnaire and generally regular updates are given, however there was no evidence that five of the staff trained in Feb 2006 had had an annual refresher. Warwickshire fire service reported that items that needed attention at the last visit had been satisfactorily completed. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 30 There was evidence available to show that the fire system and the emergency lights had been serviced in the past 12 months. There is a contract for the testing of water including temperatures and bacteria, this is completed quarterly and records are available, all appears to be safe. Other records checked indicate that the nurse call system is tested monthly, the passenger lift and portable appliances have been checked. Gas landlords safety certificate was not available and the last one was dated 4/10/04. A disposal of waste contract is in place. There was an Environmental Health Food Hygiene inspection in May 2007. Three statutory requirements were made including installing a proper extraction fan unit in the kitchen. COSHH data sheets were available for products in use and it is recommended that a copy be kept with the products. Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 2 2 2 x x 2 x 1 STAFFING Standard No Score 27 2 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 1 x 2 Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 33 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 16 Requirement Care plans must include a record of each resident’s participation in daily living and other social and leisure activities, and how this affects their well-being. These activities must be appropriate for and based on the assessed needs of each individual resident. Care plans must accurately record all changes to personal and health care and reflect more of the persons individual needs in order to demonstrate a ‘person centred’ approach to care. Daily records including those for night care, must be sufficiently detailed to fully inform staff about changes that have taken place and provide up to date and accurate information. The care plans must support any change in medication and document any visits by external healthcare professional. The nutritional needs of residents must be fully risk assessed. Care plans for residents presenting with low weight and poor nutrition must include details of regular weight and intake monitoring, and include detail of meals and DS0000004216.V343529.R01.S.doc Timescale for action 30/09/07 2. OP7 15 30/09/07 3. OP7 15 30/09/07 4. OP8 12 31/07/07 5. OP8 14 31/07/07 Chasewood Version 5.2 Page 34 6. OP9 13(2) 7. OP9 13(2) supplements. All policies and procedures for medicine management must be reviewed to and staff trained to adhere to these. Outstanding requirement from 12/05/06. All prescriptions must be seen before they are dispensed. A system must be in place to ensure that the dispensed medicines and MAR chart are checked against the prescription for accuracy upon receipt, before any administration takes place and all new residents medication is checked upon receipt with the person who prescribed the medication at the earliest opportunity. The right medicine must be administered to the right service user at the right time and dose and records must accurately reflect practice Outstanding requirement from 12/05/06 A quality assurance system must be installed to confirm staff competence in medicine management and appropriate action taken when staff fall below the required standards. Outstanding requirement from 12/05/06. Quantities of all medicines received or balances carried over must be recorded to demonstrate that all medicines are administered as prescribed. Residents must have the opportunity to exercise choice and control in relation to leisure, social activities, meals and other areas associated with daily DS0000004216.V343529.R01.S.doc 31/07/07 31/07/07 8. OP9 13(2) 31/07/07 9. OP9 13(2) 31/07/07 10. OP14 12(2)(3) 30/09/07 Chasewood Version 5.2 Page 35 11. OP16 22 12. OP26 13 13. OP29 19,Sch.2 14. OP30 18 15. OP33 24 living. Previous timescales of 31/07/06 and 30/04/07 not met. A record of complaints received must be kept, and all complaints must be fully investigated. A timely response must be given to the complainant in keeping with the homes complaints procedure. A record should then be kept of if the complaint was resolved to their satisfaction, and the actions taken. Timescale of 31/03/07 not met. Procedures must be introduced to effectively reduce the risk of cross infection in the home. The laundry must be kept clean and free from safety hazards. Staff practices must be monitored. Full and satisfactory information must be obtained on all employees. This must include exploring gaps in potential employees employment history and safety checks to confirm that staff are suitable to work with vulnerable people. Previous timescale of 28/02/07 not met. New employees must receive a suitable induction and receive training appropriate to the work they are to perform. Training and induction must be in line with the Skills for Care Knowledge Sets. Previous timescale of 28/02/07 not met. There must be in place a suitable system for reviewing and improving the quality of care provided, to demonstrate that the home is being run in the best interests of those living in the home. DS0000004216.V343529.R01.S.doc 30/09/07 31/08/07 31/08/07 31/10/07 31/10/07 Chasewood Version 5.2 Page 36 16. OP36 18(2) 17. OP38 13 18. OP38 37 19. OP38 17 Previous timescales of 31/08/06 and 31/03/07 not met. All persons working at the care home must be appropriately supervised to maintain good practice, linked to an individual training programme for staff development. Clear and informative records must be maintained and available for inspection. Previous timescales of 31/08/06, 30/11/06 and 31/03/07 not met. All areas of the home must be safe from unreasonable risk to staff and residents. Risk assessments must be completed actions taken where required and these must be regularly reviewed. Previous timescale of 28/02/07 part met. The Commission for Social Care Inspection must be notified of all accidents, incidents or events, which affect the well being of the residents accommodated in the home. Original timescales of 31/08/06, 30/11/06 and 31/01/07 not met. Safe working practices must be maintained through the induction process and refresher training for all staff in health and safety, moving and handling, fire safety, first aid, food hygiene and infection control. Previous timescales of 31/08/06, 31/12/06 and 31/03/07 not met. 30/09/07 31/08/07 31/07/07 30/09/07 Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 37 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 Good Practice Recommendations A review date included in the ‘Service Users Guide’ would ensure interested parties that the information was up to date. This should be available in different formats to account for the different needs of service users. Medication prescribed on a “when required” (prn) basis should have a supporting protocol detailing its use, signed by a clinician, to enable staff to safely administer the medicines as the doctor intended. A current medical textbook should be purchased to support staff when administering medication. 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. Individual life history’s should be further developed and transferred to the care plan for daily use. Wherever possible service users must be offered choice and the opportunity to exercise some control over their lives. This should be demonstrated in a person centred care plan and reviewed regularly to reflect changing needs and abilities. Residents would benefit from staff, where appropriate, eating alongside them to encourage independent eating and retained skills and abilities. Picture images of the menu should be available and used to offer choices to residents with dementia. The availability of appropriate finger foods should be reviewed, so that residents who prefer to eat in this way, can do so with dignity. The manager should consult with residents on how visual prompts to assist with orientation, may be best provided in this home. An assessment should be made of the bedroom furnishings to decide what needs to be replaced, consulting with the residents and or their representatives. A copy of the COSHH data sheets for products in use and should be kept with the products. 2. OP9 3. 4. OP9 OP10 5. 6. OP12 OP14 7. 8. 9. 10. 11. 12. OP15 OP15 OP15 OP19 OP24 OP38 Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Chasewood DS0000004216.V343529.R01.S.doc Version 5.2 Page 39 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!