Inspection on 02/06/09 for Chasewood

This inspection was carried out on 2nd June 2009.

CQC 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 CQC 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 09/12/08

Chasewood 08/05/08

Chasewood 08/11/07

Chasewood 15/06/07

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 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Chasewood 39 School Lane Exhall Coventry West Midlands CV7 9GE Lead Inspector Julie McGarry Key Unannounced Inspection 2nd June 2009 08:45 DS0000004216.V375682.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. DS0000004216.V375682.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address DS0000004216.V375682.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 DS0000004216.V375682.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th December 2008 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 people with a dementia. The ground floor of the home provides accommodation for fourteen people. 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 people at ground floor level, and two shared rooms. There is a passenger lift to the first floor, as well as the stairs, where accommodation is provided for eight people. 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. Information about fees are detailed in the Service User Guide for the home. Additional charges include the hairdresser, chiropody, personal toiletries, newspapers and magazines. DS0000004216.V375682.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is a one star; this means that people using the service receive adequate outcomes. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at key aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Two Regulation Inspectors carried out this unannounced key inspection on one day between 08:45 and 18:00 hours. As the inspection was unannounced the registered owner and staff did not know we were going. A Pharmacy Inspector was also involved in the inspection; she carried out a full inspection of the medication management systems and safety. Before the inspection we looked at all the information we have about this service such as information about concerns, complaints or allegations; incidents; previous inspections and reports. Ten questionnaires were sent to the service for the home to distribute to people who use the service, their relatives and advocates. We did not receive any completed questionnaires back. Five questionnaires were sent to staff, one completed questionnaire form was returned. Registered care services are required to completed an Annual Quality Assurance Assessment (AQAA). The AQAA provides information about the home and its development. This form was completed prior to the last inspection in December 2008 by the manager of the sister home at Chasewood Lodge. The home was not required to complete another AQAA before this inspection. Information from the AQAA completed in December 2008 has been used for this inspection. At this Key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Some time was spent sitting with residents in the lounge watching to see how residents were supported and looked after. These observations were used alongside other information collected to find out about the care they get from staff. We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. There were 14 people in residence on the day of our inspection. Four people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who DS0000004216.V375682.R01.S.doc Version 5.2 Page 6 use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. Throughout this report, the Care Quality Commission will be referred to as us or we. At the end of the visit we discussed our preliminary findings with the provider and the manager of Chasewood Lodge. What the service does well: People who are considering moving into the home benefit from having their care needs assessed so they can be sure the home can meet their needs. People are supported in a respectful manner and their personal care needs are met. Visitors are made welcome which supports people to maintain enduring relationships. People receive visits from representatives from local churches to meet their spiritual needs. What has improved since the last inspection? The service has improved the way care files are developed so staff should have information about what they need to do to meet peoples needs. There is evidence to show that the home has improved in their recognition and action in taking advice from other professionals when there is a change in physical or mental wellbeing. Care plans have improved to provide care staff with more information on the action to be taken by them to meet the care needs of people living in the home who experience anxiety and confusion. Medicine management has improved to help ensure people using the service are given their prescribed medicines correctly to promote their health and well being. The cupboard used to store chemical products that could cause harm to people is being kept locked. DS0000004216.V375682.R01.S.doc Version 5.2 Page 7 What they could do better: At the last inspection six requirements were made, two requirements remain outstanding: 1. Staff recruitment procedures need to improve to ensure residents are protected from the risk of harm. 2. Staff must undertake training related to safeguarding that is up to date and in line with the Local Authority policy and procedures. At this inspection a further seven requirements have been made. Two requirements relate to the safe storage and administration of medication. One requirement relates to people’s individual care plans. Although it is evident that work has been carried out to improve people’s care files, further work is required to ensure they are kept up to date and are person centred. Person centred care ensures people who use the service are at the centre of their care, treatment and support, support by staff should be carried out whilst ensuring that everything that is done is based on what is important to that person from their own perspective. Two requirements relate to the quality assurance of the service. As stated in the last inspection report, the management team need to introduce systems to review and improve the quality of the services offered by the home. The management team needs to develop a better management of the service to ensure that quality of care improves for those who live there. One requirement requires the home to ensure that all documents requested for the purpose of inspection are made available on request. One requirement is in relation to health and safety fire practices at the home. Good practice recommendations have also been made as a result of this inspection. They include: The home needs to make arrangements to ensure stimulating opportunities are offered to people that meets their individual needs and preferences. The home should review the environment for residents and plan a programme of refurbishment to ensure good management of infection control and ensure the home is in a good state of repair. DS0000004216.V375682.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. DS0000004216.V375682.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 DS0000004216.V375682.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3. People using the service experience Good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available for people wanting to live in the home to help them decide if the home could meet their needs. The assessment process for the people wanting to live in the home ensures their needs are known to staff before admission. EVIDENCE: One person has been admitted to the home for a short stay placement since the last inspection. Their file was examined to assess the pre-admission assessment process. DS0000004216.V375682.R01.S.doc Version 5.2 Page 11 The assessment provided details of the individual’s health and personal care needs, which include information on physical and mental health history, mobility, nutrition, communication and activities. The availability of this information helps to ensure that the specific care needs of each person can be identified and used to help complete a plan of care. Records on this person’s file shows that information was received from health and social care professionals prior to people moving in. A letter received from a relative written after the placement, informs that the manager of the sister home ‘Chasewood Lodge’ visited the prospective resident to undertake the assessment prior to them moving in. The information contained in the preadmission assessment was consistent with the information documented in a social service risk assessment plan. The outcome of the home’s pre-admission process is based upon information determined from one person. The ‘Information pack’ needs to be updated to reflect the Care Quality Commission details. As the home offers support to one person under the age of 65 years, the Statement of Purpose should be updated to inform of this. DS0000004216.V375682.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People would benefit from the continued development of their plans of care to ensure details the actions staff need to take to meet their needs are consistently recorded. Residents have access to healthcare services that meet their assessed needs. The medication system is monitored and improvements have been made to reduce mistakes. Improvement in the management of medication means that people can be more confident that medication will be administered as prescribed. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: DS0000004216.V375682.R01.S.doc Version 5.2 Page 13 Case files of four residents identified for case tracking were examined. Since the last inspection the acting manager has reviewed all case files. All the case files in the home have a standard ‘layout’ and are methodically structured in a way that allow staff ease of reference to information about each person. This is an improvement to that seen at the last inspection. Continued development of care files is required to demonstrate a person centred approach to care. Care plans do not record people’s preferences about how their care should be delivered, and there is no evidence to show residents and/or their representatives have been involved in drawing them up. Each person has a plan of care, daily records and monitoring records. Care plans are generally based on information secured during the initial care needs assessment, and kept under review. There was evidence that care plans are reviewed at least monthly but are not always updated when there is a change in care needs. For example, one person’s needs have changed significantly during the four weeks prior to this inspection. The care plan has not been updated to reflect that this individual is no longer mobile, and needs full personal care support. Staff spoken to were able to discuss this person’s changing needs, and show us that records of this individual’s food and fluid intake are being recorded daily. Records also showed that staff have received support from the Speech and Language Therapist in relation to meeting this person’s nutritional needs. However, as the home uses staff from the sister Home (Chasewood Lodge) to cover staff absences, the lack of information in this individual’s care plan about their current needs may result in inconsistent care which could affect the quality and type of care this person receives. Staff inform us that this person also experiences ‘seizures’ and is undergoing assessments in relation to health need. There is no record of this person having seizures in their care file, and no risk assessments in place to guide staff on what action they need to take should this person have a seizure. One person spoken with was not sure how they would react or manage a situation should this person have a seizure. Another person receives stoma care support, staff spoken to were able to discuss this person’s care needs and their role in providing stoma care. The care plan provides staff with some guidelines on the care required, for example, ‘requires assistance of one carer to toilet staff to ensure stoma bags are changed on a regular basis’. Monitoring records show that this is being done as per care plan. Although a care plan is in place to help meet this care need, it is not clear how often ‘regular’ is, this could result in inconsistent care being delivered. Another person’s care plan for diet and weight states ‘X needs encouragement at times to eat their meals’. Recent records show that ‘X has put on weight DS0000004216.V375682.R01.S.doc Version 5.2 Page 14 steadily, staff to monitor’, there is no information to tell staff how support with diet and weight needs to be provided. This person’s care plan also states they may become anxious and asks when they are returning home. The care plan tells staff to ‘explain to X why she is living here’. There is no information provided to ensure that staff are giving a consistent explanation to X as to why she is living at the home. We observed two members of staff giving different explanations to this person on the day of the inspection. The deputy manager informs us that no residents present with ‘challenging behaviour’. We are told that some people require support with anxiety and confusion due to ‘frustration’. Care plans looked at show that the home’s approach to providing support to people who are anxious/ confused has improved, and people’s records provide care staff with more information on the action to be taken by them to meet the care needs of people living in the home. Greater detail is however required to ensure staff are consistent in their approach as explained in the previous paragraph. Care plans are in place for those who need support with continence needs. One person’s care plans states that X had ‘become a little incontinent’. Instructions in the care plan state that this individual is not aware of their continence needs and would need staff support to identify when need is required and support with changing of their clothes. There was nothing recorded to demonstrate if staff had explored how X felt about this, how staff should to support to this person to ensure their dignity was respected. This does not demonstrate a person centred approach to care or what would be reflective of good dementia care practice. Risk assessments are available for areas that may cause a problem such as falls, nutrition and moving and handling. Record also show that staff are maintaining weight records, body maps for those with pressure sore concerns, food and fluid charts. There was evidence in the files that residents have access to GP, chiropody, dentist, optician and are supported to attend hospital appointments so their healthcare needs are met. Input from specialist health care professionals such as the Speech and Language therapist was also evidenced. People made positive comments when asked about the care they received in the home. ‘It’s lovely here’ ‘The staff are very good, especially this one’ (pointing to one member of staff). One relative spoken to felt their sister was receiving a standard good care at the home, and stated that they had ‘no complaints’. DS0000004216.V375682.R01.S.doc Version 5.2 Page 15 The information received from one staff survey tells us that this member of staff is ‘always’ given up to date information about the needs of the people they support and care for. The systems for the management of medicines in the home were examined. The pharmacist inspection lasted just over one and a half hours. Four people’s medication were looked at together with their Medicine Administration Record (MAR) charts, care plans and daily records. All feedback was given to the deputy manager who was present throughout the inspection. One senior care assistant was also spoken with. The home has installed and implemented a good system to check the prescriptions prior to dispensing and to check the medicines and MAR charts received into the home. The quantities of all medicines had been recorded enabling audits to take place to demonstrate whether they had been administered as prescribed. No action had been taken when one medicine had not been delivered. The deputy manager contacted the pharmacist during the inspection to find that the medicine was no longer available. Whilst the pharmacist should have contacted the doctor for an alternative medicine to be prescribed the home should have also chased this up and not just recorded that it was not available. Regular audits are undertaken to ensure that the medicines are administered as prescribed. This was confirmed during the inspection. The majority of medicines had been administered as the doctor prescribed and records reflected practice. Both the senior care and deputy manager spoken with had a good understanding of the medicines they administer enabling them to support the residents clinical needs. Drug information was available for staff to read if they did not know what a particular medicine was for. Concern was raised where one resident was not administered some of his medication as it caused drowsiness because he was very sleepy. At no point was the doctor contacted for him to make the clinical decision to stop some of the medication. Even though the staff are expected and do understand what the medicines are for they are not clinically trained to make decisions to withhold prescribed medication. The care plans recorded some of the medical information necessary for staff to support the clinical needs of the resident. One risk assessment recorded the residents constant refusal to take his medication but failed to specify exactly what action to take. No action had been taken, so the doctor was unaware of this. Staff routinely recorded that he refused his medication only. The responsible key worker updated the care plans on a monthly basis but had failed to contact the doctor, for example, for a medication review when circumstances had changed. DS0000004216.V375682.R01.S.doc Version 5.2 Page 16 There were no supporting protocols detailing how and when staff should administer medicines which had been prescribed on a “when required” basis. These would support the staff to ensure they are administered as the doctor intended and give the staff clear guidance how to. The medicines currently in use were correctly stored, including the Controlled Drugs (CD) and those requiring refrigeration. The medicine refrigerator was monitored daily to ensure that the home correctly stored those medicines requiring refrigeration. The CD balances were correct and the entries in the CD register reflected the MAR chart records. Medicines that were no longer needed we put in an open box and left in the office. All residents, staff and visitors had access to this office. An alternative locked cupboard was discussed for the unused medicines. DS0000004216.V375682.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People do not benefit from the opportunity to participate stimulating activities that reflect their own personal interests and preferences. Open visiting arrangements encourage regular contact with relatives and friends. Residents benefit from a varied, tasty and nutritious choice of food. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The range and availability of activities at the home is limited. At the last inspection there was an activities person to co-ordinate activities one day a week. Since the last inspection, the activities person has left. This was discussed with the manager of the sister home and the provider at the end of the inspection. We are informed that the home is seeking to employ a new DS0000004216.V375682.R01.S.doc Version 5.2 Page 18 activities co-ordinator. Staff spoken to told us that they are currently arranging activities in an unplanned and unstructured way. Care files hold little information about people’s individual preferences or how they wish to spend their time. Life stories are recorded, however these were not always fully completed. Daily records record the provision of personal care support, but hold little or no details that demonstrate how the home meets social or cultural needs. More detailed work in developing people’s life histories would help staff develop a more person centred approach to the care they deliver, ensuring care is providing in a way that meets each individual’s needs and preferences. On the day of the inspection we observed interaction between staff and residents, but no activity session on a group or individual level occurred. Records for one individual state ‘staff to keep xx involved in daily activities and outings’. On the day of the inspection we observed xx through the day and saw no daily activities taking place that involved this individual. This person’s daily records were seen and do not record daily involvement in activities or outings. No evidence could be provided when requested to show how the home consults the residents about a programme of activities to meet their needs or people individual preferences. One member of staff told us that people’s religious needs are considered and supported when possible. We were told that staff support people to attend church every Sunday should they wish to go. Daily records seen show that this happens. One relative spoken to confirmed that they were able to visit regularly. The resident confirmed that they were able to see their visitor and were happy about the visiting arrangements. One resident spoken to commented ‘Its alright, lots of repetition, staff very nice and friendly and helpful, food is very good’. ‘Spend the day chatting to each other, watch TV and listen to record player. In the afternoon some people go to bed, but I take a book – sometimes we have an odd game and tea and biscuits’. There are drinks available at regular intervals throughout the day. The staff have access to the kitchen and food at all times. There have been no changes to the running of the kitchen since the last inspection. Menus are held in the kitchen for a four-week period. The cook said that food orders and the menus are done at the sister home Chasewood Lodge. Therefore people in the home are excluded involvement in planning menus. However, menus showed that the people who live there have a choice of meals through the day. The menu was varied and meals appeared DS0000004216.V375682.R01.S.doc Version 5.2 Page 19 nutritious. We saw fresh cakes being prepared for tea and were told that the cook was planning to cook sausage rolls for tea. We sat with a group of residents during their lunch. They told us the food was plentiful and varied; there was always a choice. Through the meal all comments made were positive about the care provided and people felt their needs were being met. The main meal is served at midday with a light meal in the evening. One person had chosen a steak end kidney pie while another person chose gammon. Staff were available to offer discreet, timely and sensitive assistance to people who needed help eating their meal. DS0000004216.V375682.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18. People who use this service can be confident their complaints will be taken seriously and staff will respond appropriately. Staff recruitment and training are not sufficiently robust to ensure people are supported by staff who are trained to protect them and suitable to work with vulnerable adults. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a complaints policy, which is included in the service users guide and is accessible to residents and their relatives. Residents spoken to say they know how to make a complaint, however it is evident that some people may not be able to make a complaint without support. Staff told us how they would monitor for indications that individuals need help or were unhappy, for example, we observed one person struggling with their meal at lunch time, staff responded quickly by offering help. Another DS0000004216.V375682.R01.S.doc Version 5.2 Page 21 person spilt their cup of tea over their clothes, staff were aware of this and responded by assisting this person to their room to get changed. We have not received any complaints or concerns about this service since the last key inspection. Staff spoken to were aware of the complaints procedure. The home maintains a complaints register. We examined this and found that one complaint had been recorded since the last key inspection. This complaint was looked at under Warwickshire County Council’s safeguarding protocols. The complaint was not upheld, and from a discussion with the safeguarding lead practitioner from Warwickshire County Council following the inspection, it was found that the home had no case to answer to. The home however needs to ensure that we are notified of any incidents or situations that are considered under safeguarding protocols to comply with regulations. The policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults were examined. The information guides staff on the procedures to follow if they saw or suspected possible abuse. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Two members of staff were able to explain the action they would take if they saw abuse. Both answered appropriately. The AQAA sates that the home aims ‘To give a high level of protection to vulnerable adults’. At the last inspection the home was required to ensure that all staff undertake training related to safeguarding and that is up to date and in line with the Local Authority policy and procedures. According to the home’s training matrix three staff have still not received training in the protection of vulnerable adults. The manager at Chasewood Lodge informs that the staff have completed the training and the matrix is not up to date. The home however did not provide evidence to show that these three members of staff have completed this training. As stated in the last inspection report, robust recruitment processes are needed to safeguard the people who live at this home. As recorded in the last inspection report, one member of staff who had previously left Chasewood and been re-employed did not have a CRB, PoVA first or references taken up on their second employment. The home was required at that inspection to ensure sufficient information is secured to determine the fitness of potential employees before they start working at the care home. We found at this inspection, the management still had not carried out the relevant checks to ensure this person’s fitness to work at the home. It was not possible to determine from a second staff file whether the home carried out the appropriate checks before they started to work there. We DS0000004216.V375682.R01.S.doc Version 5.2 Page 22 requested that staff rotas be produced to confirm the home has followed safe recruitment practices, however the home was not able to do so. DS0000004216.V375682.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 , 20 , 26. Further work at the home is required to ensure people live in a well maintained environment. People benefit from personalised bedrooms, but do not benefit from all parts of the home being maintained to acceptable standards. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A tour of the home’s environment was undertaken at the start of the inspection. DS0000004216.V375682.R01.S.doc Version 5.2 Page 24 It is evident that continued work to ensure a clean and hygienic environment is required. Parts of the home are in a poor state of repair. For example, one bathroom, one toilet and one ensuite bathroom did not have working lights. Residents were seen to use these rooms despite one being in darkness during the day. The bin in one bathroom was full to the top of clinical waste items. Evidence of dampness and mould were also seen in this room. Not all bathrooms contained liquid soap or hand towels to help ensure good infection control management. As stated in the last inspection report, the management team should conduct a full assessment of the environment and ensure it is fit for purpose. One fire door was seen to be wedged open through the most part of the inspection. This could create a risk to the people living and working at the home in the event of a fire. If doors need to be held open, appropriate devices linked to the fire alarm system and approved by the fire service need to be provided. This will ensure that the doors close automatically when the fire alarms sound preventing or delaying any spread of smoke and fire. People’s rooms were generally personalised and clean. A range of adaptations and equipment are available to meet the assessed needs of residents including hoists, adjustable height beds and accessible baths. Call systems in rooms are accessible to residents. Specialist pressure relieving mattresses were available for those people with an identified need for them. The kitchen was clean and tidy and in good order. Daily temperature records are being maintained for the fridge and freezer showing appropriate temperatures to maintain good food safety. There also evidence that the cook is checking the temperature of food before it is served. There are risk assessments in place in relation to preparation, cooking, and cooling of foods. The laundry area has good systems of infection control. Soiled items of bedding and clothing are taken to the laundry in red clinical waste bags which are placed directly into washing machines. The laundry room is equipped with sufficient commercial equipment to manage the soiled laundry for the home and is satisfactory for the control of infection. Residents clothing are well cared for, however on examination people’s clothing were placed in the wrong laundry baskets. Some items of clothing were not labelled which could lead to people not having all their clothes returned. Protective clothing such as gloves or aprons are available to staff, these are provided for use to minimise the spread of infection. DS0000004216.V375682.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Staffing levels in the home meet the needs of the people use the service. Staff recruitment practices at the home fail to safeguard people. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Staff were seen to interact well with people living in the home throughout the day; residents were at ease making requests and asking for assistance. On the day of the inspection, the home brought staff from their sister home (Chasewood Lodge) to cover staff absence. On the morning of the inspection only one of the three staff present was part of the regular staff team who worked at the home. Staff from Chasewood Lodge also covered the afternoon shift accompanied by one regular carer from Chasewood. It was evident from discussions with the staff from Chasewood Lodge that their knowledge on the needs of people who live at Chasewood varied. Staff from Chasewood Lodge told us that they relied upon information provided by the regular carers and did not refer to the care plans. DS0000004216.V375682.R01.S.doc Version 5.2 Page 26 The deputy manager told us that the usual staffing complement planned in order to meet the needs of the 14 people currently living in the home is one manager and alt least two care staff from 8am to 10pm each day. There is one sleep in member of staff and one waking staff through the night. The acting manager is allocated days for office based worked, other days her hours are part of the allocated staffing complement. There is a member of catering staff in the kitchen between 8:00 am and 2pm to prepare breakfast and lunch. The evening meal / snack is prepared by care staff. As recorded in the complaints and protection section of this report, more robust recruitment processes are needed to safeguard the people who live at this home. The home has not met a requirement set at the last inspection to ensure all staff are suitable to work with vulnerable adults. Staff spoken to were clear about their lines of accountability and were able to tell us who they would speak to if they had any queries. Staff are aware that management support is available from the manager at the sister home – Chasewood Lodge. DS0000004216.V375682.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. The home is not being managed in the best interests of those who live there. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There has not been a registered manager at the home in excess of 18 months. This has a direct impact upon the way the service is managed. The home has an acting manager in place, who is applying to be the registered with us. The acting manager was not on duty on the day of the inspection DS0000004216.V375682.R01.S.doc Version 5.2 Page 28 however, the deputy manager and the owner were available for most of the inspection to answer any queries. Staff spoken to were clear about their lines of accountability and were able to tell us who they would speak to if they had any queries. Staff are aware that management support is available from acting manager and the manager at the sister home – Chasewood Lodge. The Annual Quality Assurance Assessment (AQAA) completed prior to the last inspection was completed by the manager at Chasewood Lodge and was of a poor standard. The document was hand written and we found it difficult to read, it did not tell us how the service meets the needs of people’s daily lives at the home. This was discussed with the manager at Chasewood Lodge during the feedback of our preliminary findings at the end of the inspection. As recorded at the last inspection, there is no formal quality assurance system. The owner states that he makes regular visit to the home, however, no formal record of the visits are maintained and when information about the home’s quality assurances processes were requested no evidence was provided. The management were unable to provide evidence of a review of working practices to identify areas for improvement in the home. The absence of an action plan for improvement means the manager cannot demonstrate that objectives were set, or measure improvement against any objective which is necessary to improve outcomes for people who use the service. The AQAA states that the home ‘engages in regular meetings with service users, families and advocates’. There is no evidence to support this statement. The management ream must develop a robust quality assurance system to assist them in running the home well and involving those who use it. We are told by the manager at Chasewood Lodge that arrangements are being put into place through the home’s solicitor to employ someone to undertake this role. The home needs to ensure that records about staff training are kept up to date and information requested for the purpose of the inspection are made available upon request. This is so the management can identify, update and respond to staff training and development needs. One survey received states that the staff member feels that they receive enough support from their line manager, however the induction program does not cover everything they needed to know to do the job when they started. Comments from the surveys include: ‘The staff empathy for the residents is great’, ‘I enjoy working at the home as the staff and residents are very nice’. DS0000004216.V375682.R01.S.doc Version 5.2 Page 29 As discussed with the provider at the last inspection, the absence of key documentation necessary to carry out the inspection of the service was also not made accessible for the purpose of this inspection. This indicates records are not being well managed, and gaps in documentation may result in high risks for people who use the service. The management also needs to ensure that recruitment processes are robust, and be able to demonstrate that staff employed are suitable to work with vulnerable adults. A requirement set out in the last inspection states ‘Staff must undertake training related to safeguarding that is up to date and in line with the Local Authority policy and procedures’. According to the home’s training matrix three staff have still not received this training. This was discussed with the manager of Chasewood Lodge who stated that the matrix had not been updated, however no further supporting evidence was provided to show that these three staff members have received the training. The personal monies of people living in the home who choose to have their money kept by the home are kept securely, and accurate records of income and expenditure are kept. An audit of two residents’ personal monies was found to be correct. Health and safety checks are being undertaken, and these were up to date with the exception of PAT tests (Portable Appliance Testing). The provider tells us that PAT has been carried out since the last inspection, however no records were provided to show this. At the last inspection six requirements were made along with a number of good practice recommendations. Evidence from management could not be provided to demonstrate that the home has met all of the requirements. Therefore two requirements remain outstanding, one relating to the safe recruitment of staff, the other relating to staff training in the protection of vulnerable adults. DS0000004216.V375682.R01.S.doc Version 5.2 Page 30 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 2 X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 DS0000004216.V375682.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes DS0000004216.V375682.R01.S.doc Version 5.2 Page 32 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 OP18 Regulation 13 Requirement Staff must undertake training related to safeguarding that is up to date and in line with the Local Authority policy and procedures. This will ensure that staff are able to identify possible abuse and to respond appropriately to protect residents. At the inspection there was insufficient to demonstrate compliance, and these will be examined at the next inspection of the service. Outstanding from December 2008 Timescale for compliance for this requirement was 02/01/09. Sufficient information must be secured to determine the fitness of potential employees before they start working at the care home. To include: Two written references, including where applicable, a reference relating to the person’s last period of employment, which involved work with vulnerable adults. A full employment history, together with a satisfactory written explanation of any gaps in employment. DS0000004216.V375682.R01.S.doc Timescale for action 02/06/09 2. OP29 19 02/06/09 Version 5.2 Page 33 The outcome of a Criminal Record Bureau (CRB) disclosure and checks against the Protection of Vulnerable Adults register (PoVA). This will ensure that the home’s staff recruitment practices safeguard people living in the home. At the inspection there was insufficient information to demonstrate compliance, and these will be examined at the next inspection of the service. Timescale for compliance for this requirement was 02/01/09. Outstanding from December 2008. Staff must contact the doctor when circumstances change resulting in people not taking their medication as prescribed. This is to ensure that the doctor can make clinical decisions surrounding the health of the person. All medicines must be stored in a locked facility when unsupervised. This is to ensure that no unauthorised person has access to medication. The care files and plans for individual residents must be audited and evaluated to ensure that they accurately reflect their current care needs and the action to be taken by staff to meet assessed care needs of people living in the home. This includes stoma care and weight loss and gain. DS0000004216.V375682.R01.S.doc 3. OP9 13 (2) 31/08/09 4. OP9 13(2) 31/08/09 5. OP7 14 31/08/09 Version 5.2 Page 34 6. OP33 26 The outcome of the audit will ensure that staff have information to provide the care people need to promote their wellbeing. Regulation 26 reports must be available to the manager so that improvements necessary can be made. 31/08/09 7. OP33 24 This is to make sure that the home is run in the best interests of people living in the home. Systems must be in place for the 31/08/09 review of working practices and quality of service delivered to people living in the home. This will ensure that home is monitoring the quality of the service it delivers to people who live there. Documents requested for the purpose of inspection must be made available on request and open to inspection. 8. OP32 17 31/08/09 9. OP38 23 This is so the home can evidence what actions have been taken by the home to comply with the Care Home Regulations 2001. Fire doors at the home must not 31/08/09 be wedged open. If doors need to be held open, appropriate devices linked to the fire alarm system and approved by the fire service need to be provided. This will ensure the appropriate precautions against the risk of fire are in place. DS0000004216.V375682.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 OP14 Good Practice Recommendations 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. Made at the last inspection. It is recommended that all medicines prescribed on a “when required” basis have supporting protocols detailing their use, to ensure that staff are fully aware how and when to administer them. Residents should be consulted about a programme of activities that takes into account individual and group needs. Records of social and therapeutic activities should include the residents’ views on the activity and whether they enjoyed this or were satisfied with the outcome. This will ensure mental and physical stimulation, which meets their individual needs. Where appropriate the person and or their relative should be involved in the planning of care and reviews to demonstrate their agreement. Where this is not possible a record should be kept to indicate this. The home should review the accommodation for residents and plan a programme of refurbishment. This is to make sure residents are provided with a pleasant environment to live in and enjoy. The management should ensure the Annual Quality Assurance Assessment is legible or completed in a format that can be accessed by the commission. 2. OP9 3. OP12 4. OP7 5. OP19 6. OP33 DS0000004216.V375682.R01.S.doc Version 5.2 Page 36 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Fax: 03000 616171 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. DS0000004216.V375682.R01.S.doc Version 5.2 Page 37 DS0000004216.V375682.R01.S.doc Version 5.2 Page 38 - 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!