Inspection on 13/04/06 for Chasewood Lodge

This inspection was carried out on 13th April 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 Lodge 23/03/10

Chasewood Lodge 06/01/10

Chasewood Lodge 17/01/09

Chasewood Lodge 12/12/07

Chasewood Lodge 23/11/06

Chasewood Lodge 02/02/06

Chasewood Lodge 09/06/05

Chasewood Lodge 04/10/04

Chasewood Lodge 18/05/04

Similar services:

Coton Hill House

Doddington Lodge

Far Croft

Churchill House Nursing and Residential Home

Field Farm House

Church Terrace Nursing & Residential Home

Fountain Court

The Forbury

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

CARE HOMES FOR OLDER PEOPLE Chasewood Lodge Mcdonnell Drive Exhall Coventry West Midlands CV7 9GE Lead Inspector Yvette Delaney Unannounced Inspection 13th April 2006 13:00 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 Lodge DS0000004215.V290189.R01.S.doc Version 5.1 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 Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chasewood Lodge Address Mcdonnell Drive Exhall Coventry West Midlands CV7 9GE 02476 644320 02476 644320 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 Ms Maria Christine Edwards Care Home 107 Category(ies) of Dementia (12), Dementia - over 65 years of age registration, with number (95) of places Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The initial number of residents accommodated will be limited to 10 on the blue unit. All building work and furnishing is completed in the blue unit prior to service users being placed and documentation showing evidence of completion is provided to the Commission All further increases in occupancy up to a total of 107 must be staged and agreed in writing with the Commission and may be subject to further site visits. Service Users admitted to the blue unit must not be subject to any disturbance in respect of the ongoing building work. The driveway and the moat must be risk assessed and be made safe for staff, service users and relatives prior to opening of the new unit. Date of last inspection 2nd February 2006 Brief Description of the Service: Chasewood Lodge Care Home is registered to provide care to 107 elderly people with dementia. At present the upper floor of the new extension is being completed. Residents have started occupying and living on the ground floor of the new extension. Chasewood Lodge is situated in a cul-de-sac and lies next to the M6. There are local shops, which are accessible and the nearest town is Bedworth. There is local bus service to the home. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection of 2006/07 inspection year and was carried out by two inspectors. The inspection visit was unannounced and was undertaken over 11 hours. The Pharmacist Inspector for the Commission carried out a random inspection on 28 March 2006. The visit resulted in a letter of serious concern being issued. The requirements from that inspection have been included in this report. The ground floor of the home has been completed is now open and residents have been admitted. Work is continuing to complete the first floor. Records relating to resident care, staff training and recruitment, supervision of staff and health and safety were examined. A tour of the home was also undertaken visiting a selection of bedrooms and communal areas. Eight residents were spoken with; two relatives were seen during this visit. Six care staff were also spoken with. The registered manager and registered provider were both available throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: There are a number of areas that the service needs to do better in: ♦ ♦ Pre-admission assessments must be completed prior to admitting a resident into the home and assurance given that their needs can be met. Care plans must identify all the care needs of residents. DS0000004215.V290189.R01.S.doc Version 5.1 Page 6 Chasewood Lodge ♦ ♦ ♦ ♦ Care plans must give clear guidance on the actions to be taken by staff to meet the needs of the residents. Risk assessments must be completed for all residents and suitable preventative care plans developed where required. Residents must be given clear choices concerning their day-to-day life in the home. A structured activities programme and details of any activities taking place must be available in the home. Suitable activities designed to meet the individual needs of residents requiring specialist dementia care were not evident. The registered manager must ensure that fire doors are not propped open. The registered provider must ensure that there is a call bell facility in the main lounge of the home to enable residents and staff to summon assistance if required. The registered manager must review the current arrangements for cleaning the home and appropriate action taken to make sure all areas of the home are clean and free from offensive odours. Recruitment procedures in the home must be reviewed to ensure a robust and consistent approach to staff recruitment and employment practices. ♦ ♦ ♦ ♦ Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Residents are not assured that their care needs can be met prior to their admission to the care home. EVIDENCE: Five care profiles were examined and the residents seen. In all of the profiles a social service care management assessment was available describing the care needs of individual residents. Residents had also received a preadmission assessment carried out by a member of staff from the home. The five pre-admission assessments examined showed that they were in various stages of completion and full assessments had not been completed. As a result care plans had not been developed to detail all the care needs of these residents. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome group is poor. This judgement has been made using available evidence including a visit to the home. Resident’s health, personal and social care needs are not set out in individual care plans, resulting in the omission of appropriate care putting residents at risk. Residents are generally treated with respect, but requests for the care and support they need are not always responded too in a timely or appropriate manner. EVIDENCE: Five care profiles were fully examined it was found that there was a lack of information to identify the actual needs of residents. Further information received from the deputy manager at the time of inspection identified that there are at least twenty-five further residents without care plans. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 10 The lack of care plans and general observations made during the inspection identified that the home was unable to demonstrate that they are able to meet many of the complex needs of the residents in relation to their dementia. Information available was not sufficient to support care staff in providing appropriate care to residents admitted to the home. Work has started on organising care profiles using an index system but this is not sufficient and does not make up for the absence of information. A relative comment card said, • “No service user pack provided yet and I’ve not been involved in agreeing care plan” In the daily records of one care profile there was mention of a resident that had demonstrated aggressive behaviour. A care plan was not available to state if there should be any specialised care intervention. Records had not been maintained of the residents’ daily behaviour, which would alert staff to recognise any changes that may cause concerns. The registered manager had been advised that a pressure mat, which would alert staff when a resident got out of bed at night would be a suitable option, this had not been followed up. A further resident spoken with had a swollen foot and was concerned that the foot was getting worse as staff did not elevate her leg as instructed following a visit to the hospital. A suitable stool was not available to ensure comfort and relief from pressure when the leg was elevated. There is other equipment to support meeting the needs of residents these include hoists and assisted bathing facilities. There was little indication that evaluation of residents care takes place to ensure that care needs are assessed and care plans implemented to reflect changing needs. There were no assessments carried out for residents who constantly walk about or ask to leave the home. As a result care plans were not in place to ensure consistency of approach and care for these residents. Risk assessments completed were limited those available include manual handling and nutrition. Assessments had not been carried out to cover individual needs related to falls, mental health and continence. The outcome of those risk assessments completed had not been used to inform care plans. Residents in the home received visits from GP’s, Community Psychiatric Nurses and District Nurses. An inspection carried out on the 28 March 2006 by the pharmacist inspector identified concerns with medication procedures carried out in the home. This visit resulted in a letter of serious concern being issued. The requirements from the inspection have been brought forward into this report. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 11 Staff were observed closing doors to toilets and residents bedrooms when they were undertaking personal care, to ensure that residents privacy was upheld. One visitor spoken with said that that while the residents’ she visits look well presented the personal care needs of some residents were not always met. For instance, when residents’ ask to go to the toilet, they are sometimes told ‘you have just been’ and the request for assistance is not responded to appropriately. ‘On one occasion when this happened the resident couldn’t wait any longer and ‘wet herself’. In a letter to the Commission prior to the visit a relative stated that residents were not always dressed in their own clothes. Observations and discussion with residents and staff found that occasionally clothes do get mixed up. This was said to be due to identification tags not been attached to residents’ clothes. Five staff spoken with said residents are well cared for. To promote privacy, a security lock is fitted to the door of residents’ rooms. Three residents spoken with said they didn’t have a key to their room and couldn’t remember whether they had been offered a key. Residents spoken with said staff are respectful and consultation with GPs takes place in the privacy of their own room. A pay phone is not available, but residents can either use the office phone, or can arrange to have their own phone installed in their private room as seen in one residents room. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. The absence of appropriate social and recreational stimulation results in residents with dementia not having opportunity to maintain life skills. There are no restrictions placed on visiting but visitors don’t always feel welcome. Freedom for residents to exercise choice in all aspects of daily living is not always promoted or facilitated. Meals are generally varied, but residents are not always offered alternatives. Food served is not always presented in an attractive or appealing manner. EVIDENCE: There are no “activity organisers” employed in this home and care staff are responsible for undertaking activities with residents. During the visit a number of residents were observed participating in activities i.e. card and board games and a softball exercise facilitated by a member of Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 13 staff and involving a number of residents. Colouring books and pencils were also available. One to one activities specifically designed to meet the individual needs of residents requiring specialist dementia care were not evident. Two residents spoken with said ‘its not bad here, staff very good, will help and listen’. One resident said she gets ‘bored to tears’. A further resident said she goes out to a club, which she enjoys. A further three residents spoken with were not aware of any trips out. A letter of concern sent to the Commission before the visit raised the following issues: • • • ‘No television reception in the new lounge’. ‘No evidence of activities or planned activities’. ‘No stimulation, interaction or input from the staff’. Members of Bedworth and Exhall Parish Church visit the home monthly and a Catholic Priest visits weekly. Holy communion is conducted in private. A chapel and sensory room are included in plans for further development. A pre inspection questionnaire completed by the manager, describing recreational activities inside the premises, and those accessed in the wider community identify: • Visits to the home by hairdressers, chiropodist, pat dog and library services. Shopping and day trips, theatre outings and a weekend away are also included in the range of activities provided. There is no structured activities programme and details of any activities taking place are not displayed in the home. Staff spoken with said they advise residents of the time and venue of any activities taking place. One resident spoken with said she had not been made aware of any activities. A number of individual life histories have been recorded, the information held varied. Of the three files viewed one was detailed and informative, one held limited information, and one was incomplete. None had been transferred to the care profile for daily use. Staff spoken with had a range of understanding of the needs of residents. Not all staff were aware of specialist dementia care needs or of when it may be appropriate to use reality orientation techniques. Staff generally interacted with residents in a manner that was often engaging and required a response. Staff were less confident when responding to the needs of a resident with poor short term memory, and who were anxious and continually asking to leave the home. Five staff spoken with were enthusiastic about their work, keen to do a good job and were caring towards the residents. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 14 Residents confirmed that their relatives and friends were able to visit at any time, and that they can always see them in private, if they choose. One visitor spoken with said she was generally made to feel welcome. A letter of concern received by the Commission prior to the visit stated. ‘In general the home is unwelcoming and staff do not acknowledge the presence of visitors’. Two residents said there were restrictions preventing them from spending time in their rooms and on getting up or retiring when they choose. Lunch is transported to the dining areas in a hot trolley. The main meal on the day of the visit consisted of ham or chicken casserole, potatoes, swede and green beans, followed by sponge pudding and custard or yogurt. This was not the same as the choices recorded on the menu. Soft, pureed and diabetic diets are provided for residents with specialist dietary needs. Food was presented in an attractive manner, but blended diets were less appealing, as the individual components of the meal were mixed together and served to residents in a bowl. This practice reduces the taste and appearance of meals. Most residents have their meals at a dining table in a lounge/dining room. Tablecloths were not used on a number of tables that had been recently recovered. This affected the overall appearance of the dining area, making it less attractive. At teatime cheese or ham sandwiches and sponge cake were available. In the evening, residents were served hot drinks and biscuits. Hot drinks were also served to residents throughout the duration of our visit. A bowl of fresh fruit was available in the area of the home known as bluebell walk A four-week menu held in the kitchen is not displayed or made available to residents. Residents spoken with were not always aware of the choices available to them. Kitchen staff said residents with dementia were offered visual choices at mealtimes. Most residents spoken to thought the food was generally good, however this was not everyone’s view. One resident said ‘you don’t have a choice you have what you’re given’. Two further residents said they didn’t like the food and were fed up with having sandwiches for tea. One week’s menus evidenced sandwiches for tea on five of the seven days. An alternative was not identified. The kitchen and food storage areas were clean and generally well managed. Food was dated before being placed in the fridge or freezer. Records of fridge, freezer and cooked high-risk foods were held and maintained. A cleaning schedule was in place and signed by staff when tasks are completed. Cleaning products were stored in a designated room at the far side of the kitchen. Food storage areas were well stocked and held a range of provisions and fresh fruit. Discussion with a kitchen assistant evidenced she has not completed basis food hygiene training. Therefore practices may be unsafe and place residents at risk. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Residents and relatives are not confident that their concerns will be investigated in an objective and timely manner. The absence of attendance by staff to adult protection training and care practices observed does not ensure that resident’s rights and protection from abuse are fully protected. EVIDENCE: The home has a procedure for handling complaints this needs to be reviewed to ensure that all the information detailed in the document is accurate. The procedure is available and accessible to residents, staff and visitors in the home. Comments received from relatives related to making complaints state that they were not happy that their complaints are dealt with appropriately. Most residents have their rights protected through the support of their relatives. Evidence was available to confirm that a number of residents are subject to guardianship and power of attorney orders. Information on how to access professional advocacy services is not displayed in the home. The home has policies and procedures for the protection of vulnerable adults. There is currently one incident, which is going through vulnerable adults procedures. Training records show that staff need to be updated with adult protection training sessions. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. The environment is varied throughout the home in relation to safety, maintenance, comfort and cleanliness, which might reduce the experience of quality of life for residents. EVIDENCE: The home continues to be in the process of having building work completed. Residents occupy the ground floor of the new extension. The first floor of the extension continues to be off limits and keeping the lift locked prevents access to residents. There is no suitable garden area around the area of the new extension for use by residents. The grounds around the home are not maintained safely, building materials are in the grounds and the moat area at the back of the home is exposed and has not been secured. The doors providing access to the back of the home are kept locked. The moat at the front of the home was made secure on the day of inspection. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 17 Records examined showed that information that would provide evidence of ongoing maintenance work carried out in the home had not been kept up to date. The flooring in the corridor providing access from the old part of the home to the new extension although stated as non-slip was causing people to slide when walking on it. Inappropriate flooring increases the risk of slips and falls for residents. The laundry facilities are sited in two areas, one in the old part of the home and one in the new build. Work required to install hand-washing facilities in the new laundry room have been completed and will be removed as a condition of registration. The home does not employ a designated laundry person choosing instead to allocate this task to care staff. The service is generally well managed. Suitable equipment and disposable gloves were available in both laundry rooms. Two residents spoken with said they were satisfied with the service provided. Residents presented as generally well groomed and their clothes ironed and colour co-ordinated. In a letter to the Commission and prior to the visit a relative complained that towels were not always provided in bedrooms and that some were of poor quality. Four of the five rooms checked had hand towels in place and although the quality varied all were considered to be of an acceptable standard at the time of inspection. The fire door leading into the kitchen was propped open by a stool on two separate occasions. An immediate requirement was issued for this practice to cease. The bedrooms seen were generally clean and tidy. Lounge and dining areas were domestically furnished. The bedrooms seen were comfortable and homely. Residents spoken with said they had all they wanted in their rooms. The bathrooms and toilets in the ‘old building’ would benefit from some refurbishment and regular cleaning. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome group is poor. This judgement has been made using available evidence including a visit to the home. Care staff are employed in sufficient numbers but the lack of suitably qualified and trained staff does not ensure that residents are in safe hands at all times. Insufficient cleaning staff also reduces the quality of life for residents and increases the risk of infection. Rigorous staff recruitment procedures necessary for ensuring the safety of residents are not in place. Therefore residents are placed at risk. EVIDENCE: At the time of the visit the staff team consisted of a deputy manager, 35 care staff, a cook, two kitchen assistants, and a domestic assistant. The deputy manager stated that staffing is based on the needs of residents and is divided between the new and old building. Four care staff are deployed into the ‘old building’ where 22 residents are accommodated. The new build is divided into three units. Two units each accommodate ten residents and have two care staff. The remaining unit accommodates five residents and has one carer. Staff are flexible and can provide any additional support on other units if called upon to do so. Five care staff provide care at night. Discussion with the deputy manager found that due to a vacancy only one cook was employed. The cook worked extra hours so as to ensure adequate staff cover. The additional hours occasionally involved working seven days a week. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 19 Duty rotas failed to identify how staff are deployed or include the role of the worker. Also excluded from the rotas were the registered manager, the cook, kitchen assistants, and domestic and maintenance staff. Therefore we cannot be sure the management and deployment of staff are appropriate to the needs of the residents. Four residents and one visitor spoken with stated there was generally sufficient numbers of staff on duty. Five care staff spoken with confirm this and stated staff turnover was low. Prior to the visit the Commission received a letter of concern about staff shortages and language difficulties. Observations and documentation evidenced sufficient numbers of staff on duty to meet the assessed care needs of residents. There was no evidence of language barriers, as residents spoken to said they could understand what the staff were saying. Having only one domestic assistant may be insufficient and may not provide a good overall standard of cleanliness. A number of areas in the home were seen as unclean notably bathrooms and toilets in the old building. Some offensive odours were also evident in two of the bedrooms. Through discussion with the staff and records it was found that twelve care staff have achieved a qualification in care. This indicates some discrepancy with the information received in the pre-inspection questionnaire. The document states that there are 50 of care staff with a qualification in care and not 30 as evidenced in staff files. Four staff spoken with were enthusiastic about training and keen to explore any opportunities open to them. Two care staff said they had attended dementia care training. Discussion with the deputy manager and documentation evidenced staff training records were not kept up to date. One senior care worker with a number of years experience had not received dementia care training, and although responsible for the administration of medication was not appropriately trained. Records show that the most recent dementia care training undertaken by some care staff was six years ago. The deputy manager stated that there was always a first aider on duty and that she was qualified to instruct staff on safe moving and handling techniques and risk assessing. A certificate confirming qualification was awarded is held. Records indicate future staff training is to include: • • • • 12 week distance dementia care and health and safety. Care plan writing. Care of the dying and death. Medication. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 20 This training is to be offered through corporate bodies i.e. Coventry & Warwickshire Partnership in Care. The staff recruitment records and the files of four staff were scrutinised. A significant number of shortfalls in the staff recruitment process were identified in some or all of the files checked these include: • • • • • • • No evidence of gaps in employment history being explored. References not always sought from the most recent employer and on two occasions not sought all. One reference obtained over the phone from a friend of the applicant and a second reference secured from the most recent employer, and where the applicant had only worked for a maximum period of four weeks. Staff photograph not obtained. Criminal Record Bureau disclosures not sought for three staff working directly with residents. Risk assessments not undertaken in respect of two staff with a criminal conviction and one with a caution. The absence of appropriate checks necessary to determine the employment status of an overseas worker. Criminal Record Bureau disclosure certificates were held in respect of 37 of the 40 staff employed at the home. Other issues raised with the deputy manager and the registered provider include: • • • The absence of under eighteen The absence of The absence of a risk assessment and job description for an employee years of age. staff interview notes. a staff induction in respect of one identified worker. The deputy manager usually conducts the staff induction process, which involves meeting with the new worker to discuss some aspects of their role and completing an induction record. Videos are used to provide initial training in the prevention of abuse and moving and handling. Staff then attend an external training course on abuse and an internal course for moving and handling training. The induction process does not include the staff code of conduct or residents rights. Records held do not include the name of any mentor, details of any supervision or shadowing that may have occurred. Future training or development needs were also not identified. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 21 One worker spoken with said her induction only ‘lasted for about 10 minutes’. Two other workers said there induction lasted longer but they didn’t feel the content was as detailed as they had expected. Three residents spoken with said the skills and knowledge of the staff varied as some were better than others and they ‘liked some more than others’. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. There are a number of areas related to the homes management and operation which need to be improved to ensure the safety of residents at all times and an increase in their self-worth and quality of life. A formal quality assurance system has not yet been introduced to monitor and ensure that all services and procedures available in the home operates in the their best interest. Records detailing how resident’s monies are handled are not appropriately maintained to confirm that residents are safeguarded from financial harm. Supervision procedures have not been implemented to monitor care practices delivered by staff, which does not support ensuring that residents’ health, safety and welfare is maintained at all times. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 23 Some practices evidence that the welfare and interests of residents are not consistently protected and safeguarded and could result in risk from harm. EVIDENCE: There are a number of areas related to the homes management and operation, which need to be improved to ensure the safety of residents at all times. As discussed in this report these include the absence of care plans for residents admitted to the home, poor recruitment procedures and training and induction of staff. Management arrangements in the home are unclear. The deputy manager is responsible for a number of management duties, which include recruitment, training and the development of care plans. There was no evidence that a structured approach to quality assurance had been implemented. The registered manager does not routinely carry out audit of systems and practices carried out in the home. The deputy manager was unaware whether independent professional advocates were supporting any residents with managing their finances. One resident was known to be managing independently, while family members support most residents Monies are held by the home on behalf of a number of residents for safekeeping and are stored safely and securely in individual envelopes. Records are held of all financial transactions, but individual receipts held do not include monies paid to the three hairdressers’ or money spent shopping on behalf of the resident. For example £40.00 spent on behalf of a resident was not supported by a till receipt or any other documentary evidence confirming a financial transaction had occurred Therefore practices are unsafe. The retention of individual receipts supports evidence that residents’ finances are protected and facilitate access to personal records, in accordance with the Data Protection Act 1998. Residents are encouraged to personalise their rooms and can bring some small items of furniture in with them. An inventory is not held of any items brought into the home. Residents have secure facilities in their private rooms for the storage of personal items and papers. Formal one to one staff supervision is not carried or used as part of the normal management process. Plans are underway to introduce staff annual appraisals. Service and contract records are available but are not all up to date. Records examined include maintenance and contracts for all services supplied to the home. Resident aids and equipment have current service records, this includes hoists and assisted baths. There was no evidence of an ongoing maintenance Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 24 programme in the home. Records were not available to evidence what day to day maintenance work had been carried out in the home. Records were completed to confirm daily or as required checks of fire prevention systems, which include alarms and fire drills. The outcome of fire drills and the response of staff were recorded. A valid and current insurance liability certificate is displayed in the home. Discussions throughout this report address concerns about the health, safety and welfare of residents accommodated in the home. Evidence of poor care practices and operations include the lack of care plans, from which to ensure staff deliver appropriate care to residents in their care. Poor recruitment procedures do not protect residents from harm. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 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 2 17 3 18 2 2 X 2 X X x X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 2 X 2 Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14, Sch.3 Requirement The registered manager must ensure that a full pre-admission assessment is carried out on all prospective residents to ensure that their needs can be met. Care plans must be written and implemented for all residents accommodated in the home. Timescale for action 31/05/06 2 OP7 15 31/05/06 3 OP7 15, Sch.3 The registered manager must 31/05/06 ensure that the care plans reflect all the care needs of the residents and give clear and concise guidance to the staff. The registered manager must ensure that there is clear evidence that the care planned is evaluated monthly and changes are made to prescribed care as required. (Outstanding from June 05) The registered manager must ensure that the resident and/or their family are involved in the care planning process where possible. 31/05/06 4 OP7 15, Sch.3 5 OP7 15, Sch.3 31/05/06 Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 27 6 OP8 12, 13 Sch.3 The registered manager must ensure that risk assessments are completed for all residents. Where a risk is determined a care plan must be devised describing the actions to be taken to minimise the risk. The registered manager must ensure that all residents are weighed at least monthly and where this is not possible an explanation must be available in the residents records. (Outstanding from June 05) The registered manager must ensure that advice received from health care professionals is acted on or the reasons for not doing so documented. Policies and procedures for good medicine management must be written in line with the Royal Pharmaceutical Society of Great Britain’s guidelines (as referred to in Standard 9.4). All staff must be trained to adhere to the policies and procedures written to ensure that all medicines are administered as the doctor prescribed and in a safe manner. 31/05/06 7 OP8 14, 17, Sch.3 Sch.4 31/05/06 8 OP8 13 30/06/06 9 OP9 13(2) 17/04/06 10 OP9 13(2) 30/04/06 11 OP9 13(2) All medicines received into the 17/04/06 home from new service users or those receiving respite care must be confirmed for accuracy with the prescribing doctor at the earliest opportunity. New supplies must be sought if they are unlabelled or secondary dispensed outside the home. A Pharmacist Inspector made this requirement. Standard was not assessed at this inspection the timescale set was 30/03/06. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 28 12 OP9 13(2) 13 OP9 13(2) 14 OP9 13(2) 15 OP9 13(2) 16 OP9 13(2) The right medicine must be administered to the right service user at the right dose and the right time and records must reflect practice. A Pharmacist Inspector made this requirement. Standard was not assessed at this inspection the timescale set was 30/03/06. The Medicine Administration Record (MAR) chart must be referred to before the medicine administration and the transaction recorded accurately directly afterwards. The reasons for non-administration must be recorded. A Pharmacist Inspector made this requirement. Standard was not assessed at this inspection the timescale set was 30/03/06. All prescriptions must be seen prior to dispensing, checked and a system installed to ensure that the dispensed medicines and MAR chart are checked against the prescription for accuracy upon receipt, before any administration takes place. The MAR chart must record the exact dose as the doctor intended to ensure that all service users are administered their medicines as prescribed. A Pharmacist Inspector made this requirement. Standard was not assessed at this inspection the timescale set was 30/03/06. The MAR chart must record all essential details including the name of the service user, their date of birth, any allergies (including none known), sequential page numbers, start date, the drug name, strength, DS0000004215.V290189.R01.S.doc 17/04/06 17/04/06 30/04/06 17/04/06 17/04/06 Chasewood Lodge Version 5.1 Page 29 17 OP9 13(2) 18 OP9 13(2) directions and route of administration and the quantity received or balance carried over from previous cycles. A Pharmacist Inspector made this requirement. Standard was not assessed at this inspection the timescale set was 30/03/06. The purchase of Controlled Drug cabinets are required that comply with the Misuse of Drugs (safe custody) Regulations 1973 and fixed to a permanent wall in a room where the temperature does not rise above 25°C for each individual unit within the home. The purchase of a medicine trolley is required to safely transport the medicine to the service users during the medicine round for each individual unit within the home. 30/04/06 30/04/06 19 OP9 13(2) 20 OP9 13(2) 21 OP9 13(2) All medicines must be stored in a 17/04/06 lockable facility at all times. A Pharmacist Inspector made this requirement. Standard was not assessed at this inspection the timescale set was 30/03/06. All Controlled Drug (CD) 21/04/06 transactions must be recorded in the CD register and witnessed by a second trained member of staff. A Pharmacist Inspector made this requirement. Standard was not assessed at this inspection the timescale set was 30/03/06. Staff drug audits must be 30/04/06 undertaken before and after a drug round to confirm that staff are correctly administering medicines and the records reflect practice. DS0000004215.V290189.R01.S.doc Version 5.1 Page 30 Chasewood Lodge 22 OP9 13(2) All medicines that are available to administer must be recorded on the MAR chart or returned to the pharmacist for destruction and not kept on the premise for use at a later date. A Pharmacist Inspector made this requirement. Standard was not assessed at this inspection the timescale set was 30/03/06. The purchase of a maximum, minimum and current thermometer is required and the three medicine refrigerator temperatures read on a daily basis. These must lie between 2°C and 8°C at all times to ensure the medicines requiring refrigeration are stored in compliance with their product licences to maintain their stability. The registered manager must ensure that the care home is conducted in a manner which respects the privacy and dignity of residents: • Care staff must make sure residents are not dressed in clothes that do not belong to them. • Care staff must attend to resident’s personal care needs, which includes requests made to use the toilet in a timely manner. The registered manager must ensure that activities in the home reflect the needs and abilities of individual residents. (Outstanding from February 06) 17/04/06 23 OP9 13(2) 17/04/06 24 OP10 12(4)(a) 30/06/06 25 OP12 4 30/07/06 Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 31 26 OP12 4, 16, Sch.1 The registered manager must ensure that there is a record of activities that take place in the home and that 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. The registered manager must ensure that visitors of residents admitted to the home are welcome and encouraged to visit the home. The registered manager must ensure that staff offer and assist the residents to make choices regarding access to their bedrooms and other areas associated with daily living. The presentation of meals including blended meals must be reviewed to ensure that it is attractive and appealing in terms of texture, flavour, and appearance. The registered manager must ensure that it is clearly recorded in the residents profiles the actions to be taken by staff when a resident refuses a meal. The action taken and outcome must be recorded. (Outstanding from June 05) The registered manager must ensure that the Complaints Policy and Procedure contains accurate information. The registered manager must ensure that all staff attend up to date training in adult protection. The registered manager must ensure that fire doors are not propped open. DS0000004215.V290189.R01.S.doc 30/07/06 27 OP12 16(2)(n) 31/07/06 28 OP13 16(2)(m) 31/07/06 29 OP14 12(2)(3) 31/07/06 30 OP15 13 31/07/06 31 OP15 12, 13 31/07/06 32 OP16 22(1)(6) Sch 4(11) 18(1)(c) 23 31/07/06 33 34 OP18 OP19 31/07/06 30/04/06 Chasewood Lodge Version 5.1 Page 32 35 OP21 36 OP22 37 OP24 38 OP26 39 OP27 The registered manager must review the bathrooms and toilets in the ‘old building’ to ensure they are safe for use by residents and where appropriate the facilities are refurbished. 23 The registered provider must ensure that there is a call bell facility in the main lounge of the home to enable residents and staff to summon assistance if required. (Outstanding from June 05) 12, 13, 23 The registered manager must ensure that all residents have an individual locked facility for private and personal items. If the resident does not wish to have this facility this must be recorded and signed by the resident and/or their representative. (Outstanding from February 06) 12 The registered manager must review the current arrangements for cleaning the home and appropriate action taken to make sure all areas of the home are clean and free of offensive odours, this must include: • The unpleasant smells in some resident bedrooms, where necessary floor covering must be replaced. • The regular cleaning of the bathroom/toilet areas in the old part of the care home. 17(2) The registered manager must Sch4 (7) ensure that the duty roster includes details of all staff working in the home, to include full name and the capacity in which the staff are working. A record of whether the roster was actually worked must also be maintained and available in the home. DS0000004215.V290189.R01.S.doc 23 31/07/06 31/07/06 31/07/06 31/07/06 31/07/06 Chasewood Lodge Version 5.1 Page 33 40 OP27 13(4)(c) The registered manager must risk assess the amount of days being worked by staff without a day off to ensure there are no risks to the health and safety of the residents or staff. The registered manager must provide accurate information, which confirms the number of care staff who have a NVQ 2 qualification or above. Recruitment procedures in the home must be reviewed to ensure a robust and consistent approach to staff recruitment and employment practices, which evidences that staff are safe to work with vulnerable adults. Systems must be put in place to formally respond to risks identified in the outcome of Criminal Records Bureau checks. The Registered Manager must ensure that all staff are up to date with mandatory training requirements. The Registered Manager must ensure that all staff attend ongoing training on conditions that affect the health and welfare of residents living in the home. For example dementia. The registered provider and manager 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. DS0000004215.V290189.R01.S.doc 31/07/06 41 OP28 18 31/07/06 42 OP29 19, Sch.2 31/07/06 43 OP29 19, Sch.2 31/07/06 44 OP30 18(1)(c) 31/07/06 45 OP30 18(1)(c) 31/07/06 46 OP31 10 31/07/06 Chasewood Lodge Version 5.1 Page 34 47 OP33 24, 26 The registered provider and manager must ensure that a suitable system is established for reviewing and improving the quality of care, provided in the home. The outcome of these must be shared with the Commission and reports available for inspection. The registered provider must make unannounced visits to the care home at least monthly to monitor the standard of care provided, inspect the premises, records of events and any complaints. A report on the conduct of the home must be prepared and a copy forwarded to the Commission. (Outstanding from February 06) The registered manager must maintain records of the purpose for which residents’ money was used and retain receipts for items or services purchased on behalf of the resident. The registered manager must ensure that all persons working at the care home are appropriately supervised. Clear and informative records must be maintained and available for inspection. The registered provider and manager must undertake environmental risk assessments so as to ensure that all areas of the home are safe for the residents and staff to use. This must include a review of the flooring in the corridor, which provides access from the old building to the new extension. DS0000004215.V290189.R01.S.doc 31/07/06 48 OP33 26 31/07/06 49 OP35 9(a) 31/07/06 50 OP36 18(2) 31/07/06 51 OP38 13, 23 30/06/06 Chasewood Lodge Version 5.1 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 2 3 4 5 6 Refer to Standard OP12 OP12 OP14 OP15 OP19 OP30 Good Practice Recommendations Following consultation with residents and their relatives’ work should be undertaken to further develop individual life histories. Resident’s interests should be recorded and used to formulate activities. The registered manager should ensure that information related to advocacy services or other independent agent is available to support residents in expressing their views. A menu offering a choice of meals should be made available to residents. The registered manager should produce a programme of routine maintenance and evidence of renewal of the fabric and decoration of the premises. The staff induction process should include the staff code of conduct and residents rights. Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 36 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chasewood Lodge DS0000004215.V290189.R01.S.doc Version 5.1 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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