Inspection on 07/12/06 for Chasewood

This inspection was carried out on 7th December 2006.

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 15/06/07

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 Yvette Delaney Key Unannounced Inspection 7th December 2006 09:00 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.V322596.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.V322596.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chasewood Address 39 School Lane Exhall Coventry West Midlands CV7 9GE 02476 738211 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Chasewood Care Ltd Mrs Catherine Tranter Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places Chasewood DS0000004216.V322596.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 supernumary to the care rota in order to complete management tasks. 11th May 2006 Date of last inspection Brief Description of the Service: Chasewood is a converted, detached property, set back from the road and providing accommodation on two floors. The home is registered to provide care for 22 elderly residents with dementia. The ground floor of the home provides accommodation for fourteen residents. There is a large open-plan communal area at the centre of the ground floor, and leading off from this area are three wings providing bedrooms, a kitchen, laundry and the managers office. There is a further lounge with a conservatory leading into the garden. Ten single bedrooms are provided for residents at ground floor level, and two shared rooms. There is a shaft lift to the first floor, as well as the stairs, where accommodation is provided for eight residents. Facilities provided on this floor are a lounge, dining room (with a kitchenette), and six bedrooms, two of which are shared rooms. There are two separate lavatories at this level, a bathroom and a shower room. On the ground floor French windows lead onto the rear garden, and the home has a small patio area to the rear of the property. To the front of the home there is parking space for about six cars. The manager has advised on 21 November that the current fees for a place in the home is £400 per week paid by the local council. Fees for privately funded residents were not supplied. Other additional charges include the hairdresser, chiropody, personal toiletries, newspapers and magazines. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection was carried out by two inspectors on Tuesday 5 December 2007 between 09.00am and 6.00 pm. Two residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home. The outcome of residents experiences are explored by meeting or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes for residents. Inspectors had the opportunity to meet some of the residents and talked to six of them about their experience of the home. General conversation was held with other residents along with observation of working practices and staff interaction with residents. Some of the residents were able to express their opinion of the service they received. Some residents found it difficult to engage in conversation due to their medical condition but were able to express their feelings through verbal and non-verbal communication. Conversations were also held with a social worker who was visiting the home about their experience of the home. Before the inspection, a random selection of residents and relatives were sent questionnaires to seek their independent views about the home. Unfortunately no comment cards were returned. Throughout the report the experiences and outcome for residents is based on observation of staff resident interaction, comments from those residents who were able to express their views and a small number of visitors to the home. The registered manager of the home completed and returned a pre-inspection questionnaire containing further information about the home as part of the inspection process. Some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 6 These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well: What has improved since the last inspection? What they could do better: Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 7 The home must be able to demonstrate that they are able to meet the needs of residents that they admit. A pre admission assessment of health and social care needs must be undertaken and a plan of care based on the initial assessment be developed and agreed. The medicine management within the home must improve to ensure the safety of the residents at all times. There is a lack of ongoing and consistent opportunities for stimulation, which means that the home fails to engage the residents who have dementia and who spend long periods with little or nothing to occupy them. The handling of complaints and incidences that may be considered abuse must be managed in line with the procedures outlined in the home. The environment should take into account and reflect the individual needs of residents and display signage and picture images to promote independence and assist with orientation. The Registered Manager must ensure that induction and health and safety training provided are in line with the specifications given by Skills for Care. Regular updates and attendance at appropriate training will support staff in achieving the necessary skills and knowledge to meet the assessed and recorded needs of residents at all times. Suitable working equipment, which supports staff to transfer safely, must be available in the home at all times. Care staff in the home must receive appropriate training in moving and handling techniques. Training must also be linked to ensuring that staff are able and competent to use lifting aids provided in the home. An annual quality audit seeking the views and opinions of residents, their relatives and other service users must be carried out. An internal audit and a copy of the findings must also be distributed and displayed in the home. The outcome of these audits must also be shared with the Commission. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 8 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.V322596.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 Quality in this outcome area is poor. People do not receive a full assessment of their needs, or receive information about the home which means that their diverse needs are not identified and planned for before they move to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not supply prospective residents with a copy of the Service User Guide or provide residents with a contract of terms and conditions. The senior carer was unaware of how and if residents are informed of any changes in fees. A resident spoken with said that they were not aware of any changes made to the cost of their care. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 10 A representative from the home does not routinely visit prospective residents to discuss their needs and to carry out an initial care needs assessment. The care profiles of two of the three residents identified for case tracking held an initial care needs assessment carried out by Social Services and a limited assessment carried out by staff at the home. One resident moved into the home without an assessment therefore the home could not be sure that they could meet their needs. The care needs assessment carried out by staff at the home is limited and insufficient to determine whether the home can meet the individuals needs. Since the last key inspection when the service was assessed as being ‘ poor ’ a placement block has been imposed by Social Services therefore, only private admissions have taken place. The home does not provide intermediate care. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. Regular update of residents’ health, personal and social care needs is not consistently completed in individual care plans to ensure the delivery of appropriate care at all times. Medication practices are poor and do not support staff to safely meet the needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Person and the registered manager from the second home owned by the Registered Person (Chasewood Lodge) were available to discuss progress with the previous requirements to develop the residents plan of care and to consistently complete daily records to demonstrate that the care Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 12 provided is as prescribed in the care plan. Although some progress has been made, these requirements have not been met. The care profiles of three residents identified for case tracking were selected for closer examination and show that some of the information secured during the assessment process has been used to formulate the care plan. While a number of improvements were noted in the range and consistency of information held, a number of gaps in care planning, monitoring and daily recording were identified. A care plan requires night staff to ‘check’ the resident by ‘knocking his door and if he does not answer open the door and check’. The care plan fails to show whether consultation about night observations has been discussed with the resident therefore giving consent or include why observations are necessary. Residents may find such practices disruptive and an intrusion or invasion of privacy. A risk assessment had not been carried out to determine the need and frequency of any observations Records held for one resident include ‘ a history of challenging behaviours’ but information held fails to identify the nature of any behaviours and how this is to be managed by care staff. Some information about the provision of personal care is held on daily records but is limited and does not always include details of how personal care needs are being met. Details of bathing and hair washing are held separately and it was noted that in two instances, records were completed three weeks in advance. The Registered Person must ensure care records are accurately maintained to reflect the care provided so that the home can be sure personal care needs are being met as prescribed in the care plan. Risk assessments are undertaken for a number of activities that may pose a risk for residents including nutrition and moving and handling but risk assessments had not been carried out for a resident who bathed independently and who told the Inspector ‘its a bit of a struggle.’ Reviews of care plans take place and although residents’ weight is monitored and recorded, outcomes are recorded in stones, pounds and kilograms. Staff spoken with said they did not know how to convert the different records and could not say whether residents had gained or lost weight. The Registered Person must ensure that there is a consistent approach to monitoring weight gain and loss so that the home can be sure health and nutritional needs are met. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 13 The senior carer in charge talked about new care plans, which are currently being introduced. Staff attended training on how to use the plans and further training to assess progress is due to take place in two weeks time. Evidence in care files demonstrates that residents have access to healthcare professionals, including General Practitioners, District Nurses, Optician, Dentist and Chiropodists. Records show a District Nurse makes regular visits to the home to provide wound care for a resident with a pressure sore. Two residents spoken to said consultations and any health care treatments take place in private. Observations show that resident’s health care needs are not always met; for example, the Inspector advised staff that a tissue wound on a resident’s ankle was without a dressing and exposed to risk of infection. Although staff were reminded on a further two separate occasions the resident remained without a dressing. Concerns about the lack of response by staff to the needs of the resident were brought to the attention of the senior carer in charge who said she would make sure a dressing was applied. Failure to respond to residents’ care needs in a timely manner could result in omission of care and a risk to their health. Throughout this inspection visit, staff were observed to be courteous and polite to residents. There was a relaxed atmosphere in the home and staff generally explained what care they were going to give to residents before any intervention. However, a carer in the communal lounge on the ground floor and without consultation used the same comb for each resident. Such practices are considered institutional, encourage cross infection and fail to promote and maintain residents’ dignity. One resident whose records were viewed spoke positively of the care they received and praised the staff and the care provided. However other comments of concerns made by this resident are included in the complaints and protection outcome section of this report. Care plans viewed failed to include details of any consultation with residents. Staff spoken to said the development and reviewing of care plans is not conducted with the residents but may in some instances involve relatives. The inspection of medication focussed on those residents being case tracked therefore on this occasion a full audit of the management of medication was not carried out. Medication and medication records of residents identified the Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 14 case tracking were checked and show a number of gaps in recording, monitoring and safe handling; for example, Double base cream prescribed to be applied four times a day to wet skin was held and being applied by the resident. Medication Administration Records (MAR) charts indicate that cream is being applied as prescribed. A conversation with the resident showed that the cream is only being applied once on alternate days and usually after the resident has shaved. The absence of a risk assessment for self-administration and effective monitoring and recording by staff is unsafe and place the resident at risk of not receiving the treatment assessed as needed. A separate visit by the Pharmacist Inspector to look at the storage, management and administration of medication will take place on a separate occasion. The Deputy Manager talked about the management of medication and said there was no protocol in place for medication to be administered as prn (given when necessary). Further investigation found that these medications were being administered regularly. During the inspection, a number of resident’s rooms were visited including those residents identified for case tracking purposes. Observations show residents clothing is poorly managed; for example, many items were stored unfolded at the bottom of wardrobes and were creased. Wardrobes in double rooms are not individualised and the inspection found that sometimes residents wore each others clothes. The Registered Person must ensure all items of clothing are ironed and returned to their owner and stored in a manner that respects the personal possessions of residents. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. The home does not provide sufficient opportunity for residents’ to participate in stimulating and meaningful activities or to exercise choice and control over day to day life in the home. Families and friends are made welcome to the home. Residents are not supported in making choices at meal times and food hygiene and safety practices put residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not employ a dedicated activities worker preferring instead to delegate responsibility for providing activities to senior carers. Occasionally outside entertainers visit the home and the local priest visits the home each Sunday. The frequency of church services held at the home varies and are either weekly or every two weeks. A senior carer spoken to said outings are arranged for residents to go out for a pub lunch at the ‘ Griffin’ and monthly Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 16 visits are made to the Civic Hall by groups of five residents. Shopping trips to Coventry and Bedworth for coffee and visits to the local park also occur. The inspector was told that there are plans set up an activity board to display photos of activities. Staff spoken with said there were restrictions placed on purchases, which limit the range of activities available to residents. There are no details of regular activities displayed or evidence of consultation with residents about the programme of activities to be arranged in the home. Records viewed held little or no information about how residents spend their time, entries noted for one resident include: ‘ watch TV, cigarette in garden’ The home has begun to do ‘ life-story’ work with some residents, which involved the resident and their relatives in producing a story about the residents life, highlighting important events from the point of view of the resident, and including some pictures and photographs where appropriate. This is often done in scrapbook style and can be as short or as long as the resident wishes. Staff said that the life stories would be used in reminiscence therapy. There is a need to increase the level of social and therapeutic activities. Care staff should take a more positive approach to activities and recognise the value of encouraging and supporting residents to participate. Once the busy early-morning period was past, it was evident that staff had time to support activities. There was evidence of some activity provision throughout the inspection and some residents were engaged with staff; for example, A carer was observed using a brightly coloured’ tactile ball’ to capture the attention of residents who appeared to enjoy the activity. Two other residents sat holding soft toys and one read a daily paper. Observations showed a resident going out independently to visit Shops and services in the area. When spoken to the resident said he makes regular visits out and has no restrictions placed on him. In the communal lounge, there was some conversation between residents in the early-morning period, and they clearly benefited from each others company. During the afternoon, many residents were observed to be asleep in their chairs and staff appeared to have little or nothing to do. An inspector visited the kitchen and talked to the cook. The kitchen was generally clean and well organised. Records of cleaning schedules, fridge and Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 17 freezer temperatures are maintained. Four weeks menus are held and planned and include an alternative. There is no system in place to allow residents to exercise their choice about what is placed on the menu. The home does not operate any system to enable the views of the residents to be sought such as holding residents meetings. Food storage areas held a range of provisions, dry goods and fresh fruit. Food held in the fridge and freezers was generally stored appropriately with the exception of cooked meat, which did not have the date of when opened, and some uncooked meat that was stored at the top of the fridge. To prevent the risk of infection and cross contamination the date when cooked meats are opened must be recorded and uncooked meats must be stored at the bottom of the fridge. Observations at breakfast show residents are offered a toast, cereals and a cooked breakfast. Two cooked breakfasts were left uncovered in the kitchen/diner on the first floor, which is also a designated smoking room. A carer told the Inspector that when residents are ready for their food the meals are reheated in a microwave oven. The practice of reheating cooked breakfasts in a microwave oven may be unsafe and should cease until the outcome of a risk assessment is known so that the home can make sure practices are safe and residents not placed at risk. The Registered Person must make sure that food is appropriately covered to reduce the risk of contamination. Tea usually includes sandwiches and soup. One resident spoken to felt there was not always sufficient food available at teatime and commented that it would be nice to have ‘ something different’ Supper is provided and usually includes jam on toast or Weetabix and a hot drink. Although it can be difficult to support residents with impaired cognition to exercise choice over their daily lives, staff were not observed to support residents in simple decisions such as the choice of meal. Observations at a mealtime showed there was a choice of cod roe or pork steaks served with mashed potatoes, carrots and peas followed by rice pudding or yogurt. Most residents had the opportunity to express a preference but a small number of residents had their meal chosen by staff and placed in front of them. Residents with impaired cognitive ability should be showed alternatives so that Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 18 they can choose in the moment and are not dependent on their memory or have their food chosen by others. Daily records hold some information about how nutritional needs are met and show that dietary needs are not always taken into account; for example a resident assessed as requiring a diabetic diet was given two large portions of bread-and-butter pudding without due regard for the resident’s specialist dietary needs. One carer spoken to said she was not aware the resident was a diabetic. The cook talked about diabetic diets and said no separate provision was made. A care plan for a resident with diabetes did not include the need for a diabetic diet. Drinks were served frequently to residents throughout the day. Staff are very busy during the meal times due to the number of residents requiring assistance, prompting or supervision to eat their meals. Care staff offered kind and sensitive assistance. Residents were observed to receive visitors in the communal lounge. Two visitors who were friends of the residents’ they were visiting and one relative commented that visiting is flexible and they are made to feel welcome. A visiting social care professional spoken to said she was always made to feel welcome. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. Residents and their families are not confident that their concerns will be listened to and acted upon in an objective and timely manner. Residents are not fully protected from abuse through poor recognition and actions in cases of neglect and omissions of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy for the home was displayed in the entrance hall of the home. One family member was aware of the complaints procedure and would complain if dissatisfied with any aspect of the service. Two Staff spoken with said they had not attended training on managing challenging behaviours or for the Protection of Vulnerable Adults (PoVA). Staff said residents are well cared for and they would report any concerns to the owner. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 20 One resident spoken to about his experiences said that although staff were generally kind he had said to one worker ’youre not my kind’ the resident continued ‘she came over and hit me with a closed fist nearly knocked my glasses.’ The resident said he reported the incident to the owner. This issue has been referred to Social Services who are undertaking an investigation and in accordance with the local arrangements for the Protection of Vulnerable Adults (PoVA)). One carer spoken to said she had some concerns about the vulnerability of a resident who used to make regular visits to the family home and return with tablets missing from the monitored dosage system. Relatives informed staff that they gave the resident extra tablets at night so that the resident would sleep. The Inspector advised the carer that concerns about the safety of the resident must be brought to the attention of the Registered Person and Social Services the lead agency responsible for the protection of vulnerable adults. During the inspection, this matter was brought to the attention of the Registered Persons who said they would make sure that Social Services are made aware of these concerns. Records show that a resident is identified as being ‘ racially abusive towards staff’ information held fails to identify how this is to be managed. Staff training does not include equality and diversity and staff may not therefore have the knowledge and understanding needed to respond appropriately to allegations or behaviours deemed racist. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24, 25 and 26 Quality in this outcome area is adequate. There is improvement in the décor of the home. There is failure to demonstrate that some areas of the environment and practices relating to laundry, infection control are safe. Inappropriate practices places residents’ health and well being at risk. This judgement has been made using available evidence including a visit to this service. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 22 EVIDENCE: First impressions when entering the home on the day of inspection were that some areas of the home looked cleaner and it was obvious that some redecoration had taken place. The Registered Person talked about the arrangements for routine maintenance and refurbishment of the home. A handy person has recently been employed to carry out routine maintenance and repair work. Since last inspection a number of internal doors have been painted and the dining room on the first floor is due to be redecorated as part of an ongoing programme of redecoration. On the day of the inspection visit the handyperson was painting the stairwell. An extra housekeeper has also been employed at the weekend. The home however is not odour free, especially some of the bedrooms where there is also a musty smell. The bins used for the disposal of clinical waste in the home do not have lids leaving pads etc. exposed, which could be contributing to odours in the home. In the laundry room, a wash hand basin is accessible and protective clothing is available but the area is not well ordered. Clean and dirty areas are not clearly defined and staff use cotton towels to dry their hands, which increases the risk of cross infection. Observations noted include: toilets on the first floor were dirty and needed cleaning, one toilet is blocked and the cistern is broken. There is no soap and paper towels in communal toilets and bathrooms, this practice is unsafe and increases the risk of infection and cross contamination. The shower on the first floor is not working, one of the baths on the first floor is cracked and there was a hole. There are currently only two baths, which are suitable for use. This means that there is one bath to every 11 residents when the home is fully occupied. Residents are encouraged to bring personal items in with them and can furnish and redecorate their private room to their own taste if they wish. Some of the bedrooms viewed are furnished with residents’ personal possessions such as family photographs and small pieces of furniture. Bed linen and pillows looked dirty poorly laundered and did not fit some of the beds properly. The home had a variety of aids and adaptations available including shaft lift, emergency call system and hand grab rails. The hoist in the home was not Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 23 working and carers said that this was due to the batteries being at the other care home owned by the Provider. The failure to have a working hoist in the home put a resident at risk during moving and handling techniques described under the ‘Health and Personal Care’ section of this report. The heating, lighting and ventilation in the home appeared to meet the needs of the residents. Windows had restrictors fitted where necessary and water temperatures checked were appropriate. A visit to a shared room showed that one resident who gets up in the night to go to the toilet had no access to a bedside light and is therefore at risk. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Appropriate numbers of staff are on duty to meet the needs of the residents accommodated in the home. Staff are not all skilled, competent and able to meet the changing needs of people living in the home. Recruitment practices and procedures are not followed consistently to ensure the safety of residents at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection there were 19 residents living in the home. Staffing levels were appropriate for the needs of the residents with four staff on duty during the morning shift. The home is still without a manager, one of the senior care staff is responsible for management duties in the home under the direction of Maria Edwards the registered manager for the sister home Chasewood Lodge. Catering, domestic and maintenance staff are also employed in the home. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 25 One recently employed care staff said that she had an induction period of 3-4 days. The induction covered a tour of the home, introduction to residents’ and basic care practices and procedures related to the care home. The carer was able to confirm that she had attended fire training, moving and handling and training related to the Protection of Vulnerable Adults (PoVA). Information supplied in the pre-inspection questionnaire shows that 7 of the 18 care staff working in the home have, or are working towards, a National Vocational Qualification (NVQ) in Care at Level 2 or above. A copy of a training matrix shows that attempts have been made to update staff training in the home. Examples, of recent training include Protection of Vulnerable Adults Training (PoVA). Six care staff received training in Moving and Handling and the same six staff training in care planning in November 2006. All staff have attended one fire awareness session this year. Training is very scanty and is not up to date for all staff, therefore we cannot be sure that all staff have the necessary skills to meet the assessed and recorded needs of residents at all times. The registered provider needs to ensure staff receive training in line with the specifications laid down by Skills for Care to ensure they had the necessary skills and knowledge to care for the residents. Staff files were examined for six of the most recently appointed care staff. Improvements were seen, the files were organised and contained most of the information required. Signed temporary contracts were available in files. Records were available to confirm the outcome of Criminal Records Bureau investigations. One file did not contain a commencement of employment date. The contents of a file for another member of staff showed that the previous employer had not been approached for a reference. These practices demonstrate that recruitment procedures are not consistently followed, which could expose residents to risk. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is poor. The absence of an effective manager means that there is a lack of leadership, direction and accountability of roles. This means that the welfare and wellbeing of residents are not consistently protected and safeguarded and could result in risk from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Management cover is currently provided by Maria Edwards the registered manager for the sister home Chasewood Lodge. Someone has been Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 27 interviewed for the manager’s post. Information provided suggests that the new manager is due to start in January 2007. As with the random inspection in October, observations during the inspection identified that, there was no clear leadership and direction in the home. Examples of this include the lack of organisation and again poor care practices related to moving and handling techniques. The service holds residents’ personal monies for safekeeping and purchase items on behalf of residents. Money belonging to individual residents is held separately in plastic wallets and staff record individual financial transactions in a designated book. Examination of documentation shows discrepancies in the way residents’ finances are managed; for example, individual receipts are not sought for hairdressing services and are not held for other financial transactions recorded including four occasions when cigarettes were purchased on behalf of residents. Relatives and residents depositing money for safekeeping are not always issued with a receipt; for example, £60 received from a relative had not been receipted when the money was deposited. When asked a staff member showed the Inspector a receipt but the date did not correspond with the entry made in the financial transaction book. The staff member said she could not find a receipt and decided to complete and sign a receipt retrospectively. Other information secured shows that a senior employee has access to a PIN and bankcard belonging to a resident and makes financial withdrawals on the resident’s behalf. Documentation confirming the registered manager or any other senior member of staff has authorisation to act on the residents behalf was not available for inspection. A care plan identifies the need ‘to encourage to manage own finances and not to exceed their personal allowance and therefore prevent him from having debts’. Information held fails to include details of the action to be taken by staff to make sure the resident has a positive outcome. Risk assessments to protect the resident’s Personal Identification Number (PIN) and bankcard and for the arrangements, for cash withdrawals from the bank had not been carried out therefore practices are unsafe and place the resident at risk. Records belonging to one resident show independent professional advocacy services support the resident to manage their finances. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 28 A fire door leading from the communal lounge and dining area into the kitchen is wedged open and may place residents at risk. Advice must therefore be sought from the fire officer to determine whether this presents a risk to residents. Observation of care practices show that staff do not have access to the equipment they need to transfer residents safely. Care staff were also seen to use poor techniques for moving and handling; for example, staff tried unsuccessfully to lift a resident out of a wheelchair without first applying the brake or lifting the residents feet off the foot rests. The moving and handling belt used by staff to assist the transfer was too small and staff used an unsafe underarm method of lifting known as a ‘ drag lift’ Inspectors intervened and stopped the activity to prevent the resident sustaining possible injuries. Incorrect use of moving and handling equipment put the resident at risk of injury. The care plan for this resident said that they should be hoisted. Inspectors were told that the hoist was not working, as there was no battery. A review of health and safety was undertaken. The home confirmed in a preinspection questionnaire forwarded to the commission that health and safety checks had been completed. Records examined include maintenance, contracts and servicing documentation for electrical appliances and the various hoists used for lifting and transferring residents. There was evidence that tests and services in these areas were up to date. There is no recorded evidence in the home to suggest that risks in working practice and activities are being reviewed regularly which is essential in health and safety management nor following any accident or incident in the home. Records of incidents and accidents are being recorded on home records but are not being forwarded, as required under Regulation 37 of the Care Home Regulations, to the Commission for Social Care Inspection. Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 29 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 1 1 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 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 X 2 2 X 2 3 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 1 1 3 2 Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5 Requirement The registered person must produce a written guide to the care home (“service user’s guide) and supply a copy of the guide to each service user. The registered person must produce a written guide to the home to the care home, which includes the terms and conditions in respect of accommodation to be provided, including the amount and method of payment of fees. Where a local authority has arranged for the provision of accommodation, nursing or personal care at the care home, the service user must be supplied with a copy of the agreement specifying the arrangements made. The registered person must ensure that a full pre-admission assessment is carried out on all prospective residents to ensure that their needs can be met. Previous timescales of 31/05/06 and 31/08/06 not met. DS0000004216.V322596.R01.S.doc Timescale for action 28/02/07 2 OP2 5 31/01/07 3 OP3 14(1) 31/01/07 Chasewood Version 5.2 Page 31 4 OP4 12 5 OP7 15 6 OP8 12 7 OP9 13(2) After consultation with the service user or a representative, the registered manager must prepare a written care plan as to how the service users’ needs in respect of his health and welfare are to be met. The registered provider must ensure that the resident and/or their representative receive information confirming that their assessed needs can be met by the home. Previous timescale of July O5 not met. The registered person must ensure that individual assessments and care plans accurately reflect individual residents care needs and are subject to periodic review. The registered person must ensure that the home is appropriately conducted to make proper provision to meet the care and treatment needs of service users. The registered provider must ensure that all staff adhere to the policies and procedures written to ensure that all medicines are administered as the doctor prescribed and in a safe manner. This is a requirement from the Pharmacist inspection Outstanding from 12/05/06 The registered provider must ensure that the right medicine is administered to the right service user at the right dose and the right time and records must reflect practice. This is a requirement from the Pharmacist inspection Outstanding from 12/05/06 28/02/07 31/01/07 31/01/07 31/01/07 8 OP9 13(2) 31/01/07 Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 32 9 OP9 13(2) The registered provider must ensure that care staff refer to the Medicine Administration Record (MAR) chart before the medicine administration and the transaction recorded accurately directly afterwards. The reasons for non-administration must be recorded. This is a requirement from the Pharmacist inspection Outstanding from 12/05/06 31/01/07 10 OP9 13(2) The registered provider must purchase a Controlled Drug cabinet that complies with the Misuse of Drugs (safe custody) 1973 and fixed to a permanent wall in a room where the temperature does not rise above 25ºC. This is a requirement from the Pharmacist inspection Outstanding from 12/05/06 31/01/07 11 OP9 13(2) The registered provider must ensure that all prescriptions are seen prior to dispensing, checked and a system installed to ensure that the dispensed medicines and MAR chart are checked against the prescription for accuracy upon receipt, before any administration takes place. This is a requirement from the Pharmacist inspection Outstanding from 12/05/06 The registered provider must ensure that a doctor supports any dose changes in writing. This is a requirement from the Pharmacist inspection Outstanding from 12/05/06 31/01/07 12 OP9 13(2) 31/01/07 Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 33 13 OP10 12(4)(a) 14 OP12 16(2)(m) (n) The registered manager must 28/02/07 ensure that the care home is conducted in a manner which respects the privacy and dignity of residents: • Residents are not dressed in clothes that do not belong to them. • The standard of laundering clothing must be improved. The registered manager must 28/02/07 ensure that: • Records of activities that take place in the home are kept and staff maintain a written record of residents’ participation. • The registered manager must consult with residents about the programme of activities to be arranged in the care home. Original timescale 31/08/06 15 OP14 12(2)(3) The registered manager must ensure that service users have the opportunity to exercise choice in relation to leisure, social activities, meals and other areas associated with daily living. The registered person must ensure that care staff follows the specialist dietary needs of service users. Suitably qualified or trained persons must reassess changes to dietary needs. The registered person must ensure that the practice of reheating food in a microwave oven does not continue until the outcome of a risk assessment is known to make sure practices are safe and residents are not placed at risk. 28/02/07 16 OP15 14 28/02/07 17 OP15 14 31/01/07 Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 34 18 OP16 22 The registered person must 31/03/07 ensure that any complaint is fully investigated and a timely response provided to the complainant in keeping with the homes complaints procedure. The registered provider must ensure that all staff attend up to date training in adult protection and records are available to confirm attendance. Original timescales of 31/08/06 and 30/11/06 not met 31/03/07 19 OP18 18 (1) (c) 20 OP21 23 The registered provider must 31/03/07 ensure that sufficient numbers of lavatories, baths and shower facilities are suitably adapted and accessible to meet the needs of residents. Original timescale of 30/11/06 not met. The registered person must ensure that equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order. Original timescale of 31/12/06 not met. 21 OP22 23 28/02/07 22 OP24 23 The registered person must provide in rooms occupied by service users adequate furniture, bedding and other furnishings, including curtains and floor coverings and equipment suitable to the needs of service users. Original timescale of 31/12/06 not met. 28/02/07 Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 35 23 OP26 23 24 OP28 18 25 OP29 19,Sch.2 26 OP30 18(1)(c) The registered manager must take appropriate action taken to ensure that all areas of the home are clean and free of offensive odours. The registered provider must have arrangements in place to ensure that at least 50 of care staff on duty at any one time have a National Vocational Qualification in Care at level 2 or above. The registered person must obtain full and satisfactory information on all employees. This must include professional references from the most recent previous employers. The registered person must ensure that: • At all times suitably qualified, competent and experienced persons are working at the care home. • Persons employed receive training appropriate to the work they are to perform. Original timescale of 31/08/06 not met. The registered provider must appoint an individual to manage the care home and must forthwith give notice to the Commission of: • The name of the person so appointed; and • The date on which the appointment is to take effect. The registered person must be able to demonstrate what management systems are in place to ensure the suitable running and management of the home. Evidence must be available to demonstrate the effectiveness of these systems. DS0000004216.V322596.R01.S.doc 31/03/07 31/03/07 31/01/07 28/02/07 27 OP31 8(1)(a) 08/01/07 28 OP32 10 31/01/07 Chasewood Version 5.2 Page 36 29 OP33 24 The registered person must establish and maintain a suitable system for reviewing and improving the quality of care, provided in the home and shall supply the CSCI a report in respect of any review. Original timescale of 31/08/06 not met. The registered person must maintain records of the purpose for which residents’ money was used and retain receipts for items or services purchased on behalf of the resident. Original timescale of 31/08/06 and 30/11/06 not met. The registered person must ensure that all persons working at the care home are appropriately supervised. Clear and informative records must be maintained and available for inspection. 31/03/07 30 OP35 9(a) 28/02/07 31 OP36 18(2) 28/02/07 32 OP38 37 33 OP38 17 Original timescale of 31/08/06 and 30/11/06 not met. The registered person must 31/01/07 ensure that the Commission is notified of any accidents, incidents or events, which affect the well being of the service users accommodated in the home. Original timescale of 31/08/06 and 30/11/06 not met. The registered person must 31/12/06 ensure safe working practices through the induction process and refresher training for all staff in moving and handling, fire safety, first aid, food hygiene and infection control. Original timescale of 31/08/06 and 31/12/06 not met. Chasewood DS0000004216.V322596.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 OP10 Good Practice Recommendations All residents should be offered a key to their bedroom, unless there are clear reasons for not doing so. Details of any restrictions should be recorded in the individual’s care plan. Resident’s interests should be recorded and used to formulate activities. Activities should be expanded to include the use of items for promoting mental agility or encourage finer dexterity skills. Individual life history’s should be further developed and transferred to the care profile for daily use. A menu offering a choice of meals should be made available to residents. Picture images should be used to offer choices to residents with dementia. The registered manager should produce a programme of routine maintenance and evidence of renewal of the fabric and decoration of the premises. Signage and pictures should also be used to aid orientation around the home. The appointment of a designated laundry person should improve and maintain the standard of residents clothing and would provide greater accountability. Information on how to access professional independent advocacy services should be displayed in the home. Further training is recommended and medical information available to ensure that all staff know or have access to information about the medicines they administer. Further training is recommended and medical information available to ensure that all staff know or have access to information about the medicines they administer. 2. 3. 4. 5. 6. 7. 10. 11. 12. 14. OP12 OP12 OP12 OP15 OP19 OP22 OP27 OP35 OP9 OP9 Chasewood DS0000004216.V322596.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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.V322596.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. 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