Inspection on 13/09/06 for Chatham House

This inspection was carried out on 13th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chatham House 28/09/09

Chatham House 08/10/08

Chatham House 29/01/08

Chatham House 31/07/07

Chatham House 15/12/05

Chatham House 24/06/05

Chatham House 01/02/05

Chatham House 06/07/04

Chatham House 11/02/04

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

CARE HOMES FOR OLDER PEOPLE Chatham House Chatham House 44/46 Wembdon Rise Bridgwater Somerset TA6 7QZ Lead Inspector Kathy McCluskey Key Unannounced Inspection 10:15 13 September 2006 th 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 Chatham House DS0000015985.V306213.R02.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. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chatham House Address Chatham House 44/46 Wembdon Rise Bridgwater Somerset TA6 7QZ 01278 427758 01278 427758 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) MRS JESSIE JOAN POPE MRS JESSIE JOAN POPE Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th December 2005 Brief Description of the Service: Mrs Pope is both the Registered provider and registered manager of Chatham House. Chatham House is situated in the residential area of Wembdon, 2 miles from Bridgwater town centre. The home is registered to provide personal care for up to 26 service users over the age of 65yrs. The home is not registered to provide nursing care, nor is it registered to provide dementia or other specialist care. Two large Victorian houses are linked by a modern annexe. There is car parking at the front of the house. To the rear there are extensive gardens with wheelchair access and handrails with a pleasant patio area. Accommodation is on two floors, comprising of 22 single bedrooms and 2 double rooms. There are 19 rooms with en-suite WC facilities, some have a bath (some not in use)/shower facility. TV points are available in each room. There is a passenger lift and two sets of stairs to the first floor, one with stair lifts. The communal rooms comprise of a very large lounge with three distinct seating areas, a smaller lounge and an adequately sized dining room. There are three payphones in different locations in the home, plus the use of a mobile phone for incoming calls. There is a call system fitted to all areas of the home. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key inspection was carried out in line with the CSCI framework ‘Inspecting for Better Lives 2’. This unannounced key inspection was carried out over one day (5.5hrs) by CSCI Inspectors Kathy McCluskey and Lesley Jones. The registered provider/manager Mrs Pope and her deputy Ms Hall were available for the duration of the inspection. At the time of this inspection 26 service users were living at the home (including one service user who was in hospital). During this inspection the inspectors spoke to a number of service users and staff. Comments are included in the body of this report. A tour of the premises was carried out where communal areas and the majority of bedrooms were seen. Records were examined relating to service users, staff, medicines and health and safety. The inspectors would like to thank service users, staff and management for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Chatham House provides a comfortable and homely environment for older people. The home and gardens have been suitably adapted to ensure that all service users, whatever their level of mobility, have access all areas of the home. Service users are encouraged to personalise their bedrooms and to make Chatham House their home. Service users spoken with informed the inspectors that their privacy was respected. The home has three payphones sited around the home for use by service users. The home has spacious communal areas. Service users spoken with stated that they liked living at Chatham House and really liked their bedrooms. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 6 Service users confirmed that they chose how and where to spend their day, what time to get up and go to bed. Service users appeared comfortable and ‘at home’ in their surroundings. The home has a mini-bus and service users stated that they enjoyed their weekly ‘mystery tours’. Service users benefit from a stable management and staff team. Staff turnover is low and on the day of this inspection, staff morale was good. Mrs Pope has owned and managed Chatham House since 1983 and is supported by her daughter Ms Hall. Senior staff are identified on each shift to enable them to take responsibility for visitors queries, professional visitors and decision making when Mrs Pope or Ms Hall are not on the premises. Comments from service users about the management and staff team were positive. Meals at the home are ‘home cooked’ and a four week menu maintained. The registered provider/manager informed the inspectors that menu choices are determined by service users. The provider/manager has agreed to display the daily menu in a more prominent position to aid service users. Service users spoken with were positive about the meals at the home and stated that they ‘liked the milky drinks at bedtime’. What has improved since the last inspection? The home’s procedures for staff recruitment have improved. Staff do not commence employment until satisfactory enhanced CRB and POVA checks have been received. Further improvements are required relating to obtaining references. The programme of electrical rewiring of the home has progressed and continues. At the last inspection, it was identified that one bedroom needed a ‘deep clean’. At this inspection, all areas of the home were clean and free from malodours. Redecoration of the home is on-going and some areas will benefit from this. The home’s quality assurance systems have improved and are being further developed. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chatham House DS0000015985.V306213.R02.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 Chatham House DS0000015985.V306213.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Standard 6 is not applicable, as the home is not registered to provide intermediate care. The quality for this outcome group is good The home takes appropriate steps to ensure that prospective service users have the information they need to enable them to make an informed choice about moving to the home. Service users are assessed prior to a placement being offered. The home has been suitably adapted to meet the needs of older people who may have mobility difficulties. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide which are made available to service users, prospective service users and their representatives. The inspectors were informed that there had been no changes to these documents since the last inspection. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 10 The home provided the inspectors with information regarding the home’s fees. Fees range from £370 per week for a double room and £390 per week for a single bedroom. Additional charges met by service users include: chiropody, personal toiletries, hairdressing, newspapers/magazines and some personal care products. Prospective service users are assessed prior to a placement being offered. This is to ensure that the home can meet the assessed needs of the individual. Copies of pre-admission assessments are maintained in service user’s care plans. The provider/manager also obtains assessments from other professionals where available. Prospective service users and/or their representatives are encouraged to visit the home prior to making a decision to move there. The home offers a trial period on admission to ensure that all parties are happy that the home is meeting the service users needs and expectations. Chatham House has been suitably adapted to meet the needs of older people who may have mobility difficulties. A shaft lift and stair lift give access to first floor accommodation. Ramps, grab rails and a nurse call system are appropriately sited throughout the home. The large well-maintained garden has also been fitted with ramps and grab rails to ensure that service users can access safely. Chatham House DS0000015985.V306213.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The quality in this outcome group is adequate. Staff have a good knowledge of the needs and preferences of service users though the home’s care planning systems require improvement. The home’s procedures for the management and administration of medication are generally good though some improvements are needed. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: The inspectors spoke with a number of staff and service users at this inspection and it was evident that staff had a good understanding of the needs and preferences of service users. Service users spoken with informed the inspectors they felt staff were meeting their assessed needs and that any assistance with personal care was carried out in a kind and respectful manner. Specialised equipment was seen to be in place where there was an assessed need. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 12 The inspectors noted that, in some bedrooms there appeared to be care instructions for staff displayed on walls/doors. To further promote the dignity of service users, the provider/manager was advised to ensure that these are placed in the individual’s care plan. Some prompts were seen displayed for service users. This was felt to be appropriate providing it remains in line with the individual’s wishes and needs. Although no concerns were raised or noted regarding the home meeting the needs of service users, the home’s systems for documenting individual’s assessed needs requires improvement. Four service user care plans were examined at this inspection and it was noted that assessments had not been reviewed for a considerable period of time. The home needs to ensure that assessments relating to moving and handling needs, prevention of falls and pressure sores and nutrition contain relevant and detailed information. Where appropriate, assessments should include any specialised equipment in use and identify the number of staff required to carry out a task. This relates in particular to moving and handling needs. The home needs to ensure that care plans are up to date and contain sufficient information on the assessed needs of the individual and to include clear instructions for staff on how the assessed needs should be met. Care plans should be ‘person centred’ and should take into account the preferences of service users. Service users should, wherever possible, be involved in the care planning process. Care plans should be reviewed at least monthly. To ensure the health and well-being of service users are monitored, the home should ensure that the weights are recorded monthly with action taken where there are concerns. In the care plans examined, weights had been recorded in August, but there were no entries made between March and July. A care plan relating to one service user who was an insulin controlled diabetic was examined. This did not contain any information as to how this was being managed. The provider/manager informed the inspector that the needs of the service user were being managed by a district nurse who maintains their own records. The provider/manager also stated that she had informed staff on the basic signs and symptoms of hypo and hyperglycaemia. The provider/manager was advised to ensure that appropriate information is maintained in the service user care plan and to include action to be taken by staff where there are concerns. The home’s care planning procedures were discussed in detail with the provider/manager at the time of the inspection. As previously mentioned, no concerns were raised regarding the assessed needs of service users being met. Service users were positive regarding the care they received. A selection of quality questionnaires completed by relatives Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 13 were viewed and these also indicated that they were very satisfied with the care provided. During the inspection, staff were heard communicating with service users in a kind and respectful manner. Service users appeared relaxed and comfortable in the presence of staff. It was apparent to the inspectors that personal care needs had been met. All service users appeared well attired. The homes procedures for the management and administration of medication were examined. Medicines were found to be appropriately stored. Medicines are administered by the senior carer on duty. Hand transcribed entries on the medication administration records (MAR) should be confirmed by two staff members to reduce the risk of errors. A number of opened creams were found in service user bedrooms. Once opened, creams have a limited shelf life and should therefore be identified with the open/expiry date. These issues were discussed with the provider/manager at the time of the inspection. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The quality in this outcome group is good. Service users choose how and where to spend their day. The home needs to ensure that documentation/records reflect what is being offered and identify the preferences of service users. The home welcomes visitors in line with the wishes of service users. Service users benefit from a wholesome and varied menu. EVIDENCE: Service users spoken with informed the inspectors that they choose how and where to spend their day. During the inspection, service users were observed moving freely around the home and appeared comfortable in their surroundings. Some service users informed the inspectors that they preferred to spend time in their bedrooms. Service user care plans examined did contain some information relating to hobbies/interests. Wherever possible the home should work with the service user or family to obtain a more detailed social history as this will assist staff to develop a greater understanding of individual’s and will assist in promoting a more person centred approach to care. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 15 A weekly programme of activities was seen to be displayed in one of the lounges. Information was limited and highlighted weekly trips out. When asked, service users stated that ‘there is not much going on’ and ‘sometimes you just sit around which can be boring’. Some service users stated that they enjoy the weekly ‘mystery tours’ in the home’s mini-bus. It appears that five or six service users are taken. Although staff interactions with service users were noted to be kind and respectful, it was not clear whether staff spend regular ‘quality time’ chatting with service users as this was not observed during the inspection or commented on by service users. It has been recommended that the home maintains a record/diary of activities for each individual which will identify activities/time offered and comments as to whether this was enjoyed or not, by the individual. The provider/manager stated that routines in the home were dictated by service users and that a range of activities were offered. Serious consideration should be given to the recommendation made, as this will demonstrate what is being offered by the home and will provide the home with important feedback from service users. Visitors are welcome at any reasonable time in line with the wishes and preferences of service users. Service users can choose where they see their visitors and can use the privacy of their bedrooms if they wish. ‘Quiet lounges’ are also available. Service users spoken with confirmed that they could see their visitors in private. On examination of a selection of bedrooms, it was apparent that service users are encouraged to personalise their private space. All service users spoken with informed the inspectors that they really liked their bedrooms. The provider/manager informed the inspectors that service users can also bring their own furniture if they wish. Through discussion with the provider/manager it was apparent that she strives to ensure that service users feel that Chatham House is their home. A four-week menu was shown to the inspectors. Options appeared wholesome and varied. The provider/manager informed the inspector that the menu is devised from preferences given by service users. A four-week menu is currently maintained in a book in the dining room. Service users spoken with informed the inspectors that they did not know what was for lunch. This was discussed with the provider/manager who agreed to display in a prominent position for service users. This will be followed up at the next inspection. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 16 The home has a good-sized dining room. Lunch was observed being enjoyed in a relaxed and unhurried manner. Service users spoken with were positive about the meals available and stated that there was always plenty to eat. A number of service users spoken with stated that they really enjoyed the milky drinks at bedtime. The kitchen was seen to be clean and well organised. The home must ensure that daily temperatures are recorded for the fridge and freezer. (refer to standard 38). Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality in this outcome group is adequate. The home has a satisfactory complaints procedure in place. The home’s systems for reducing the risk of harm or abuse to service users need some improvement. EVIDENCE: A satisfactory complaints procedure is available in the home. Service users informed the inspectors that they would raise any concerns with the provider/manager if they had any. Complaints records made available to inspectors indicated that the home had not received any complaints in the last 12 months. No complaints have been received by the CSCI since the last inspection. No concerns were raised by service users or staff at this inspection. The provider/manager informed the inspectors that she has arranged for staff to receive training in the Protection of Vulnerable Adults. Progress will be followed up at the next inspection. The home was able to demonstrate that it had followed its’ staff disciplinary procedures. The provider/manager was advised of the need to follow the Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 18 Department of Health’s Guidance on the Protection of Vulnerable Adults. It was agreed that confirmation that this had been addressed would be forwarded to the CSCI. A requirement has been raised relating to the home’s procedures for staff recruitment (Refer to standard 29) Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 19 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, 20, 21, 22, 23, 24, 25 and 26 The quality in this outcome group is good Chatham House provides a comfortable, clean and homely environment for service users. The home has been suitably adapted to meet the needs current service users. Appropriate aids and adaptations are in place. Service users with all levels of mobility are able to access the home’s extensive gardens. EVIDENCE: Chatham House is situated in the quiet residential area of Wembdon, which is approximately 2 miles from the centre of Bridgwater. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 20 Chatham House consists of two large Victorian properties which have been linked together to provide accommodation for up to 26 service users aged 65yrs or over. The home has been suitably adapted to meet the needs of older people who may have mobility difficulties. The home has interesting and extensive gardens to the rear, which are accessible to wheelchair users. Ramps and grab rails are appropriately sited. Car parking is available at the front of the property. The provider/manager stated that she is committed to ensuring that service users live in a homely environment. Service users spoken with stated that they liked living at Chatham House and really liked their bedrooms. Service user accommodation is arranged over two floors with a shaft lift and stair lift providing access for those who are unable to manage stairs. There are 22 single bedrooms and 2 doubles. 19 bedrooms have en-suite toilet facilities. Some are fitted with a shower/bath. Screening is available in the shared bedrooms. The home has a range of communal space, which include a very spacious lounge which has patio doors and views over the garden. A smaller lounge is also available. This also has views over the garden and patio doors. The inspectors were informed that service users tended to favour the larger lounge and that the small lounge was utilised when service users received visitors. The large reception area and spacious corridors/landings help to give a feeling of space. Seating is also available in some of these areas. There is a good-sized dining room which looks out at the front of the house. There adequate communal toilets appropriately sited around the home. The home has a walk-in shower and assisted bathing facilities. As previously mentioned, grab rails and ramps are appropriately sited. A nurse call system is installed in all bedrooms and communal areas/facilities. The home appeared to have adequate storage arrangements. A selection of bedrooms were examined at this inspection. Bedrooms were found to be clean and personalised. Specialised equipment was in place in some bedrooms seen. All bedrooms seen had comfortable seating available. Bedroom doors are fitted with a lock, which can be over-ridden by staff in the event of an emergency. All areas of the home seen benefited from natural light. To ensure the health and safety of service users, radiators are fitted with a guard, wardrobes secured to the wall and upstairs windows are restricted. Hot water outlets are fitted with thermostats to reduce the risk of scalding. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 21 On the day of this inspection the home was clean and free from malodours. Sluice provisions were not examined at this inspection and will be followed up at the next inspection. Hand washing facilities are appropriately sited in the home. Staff have access to protective clothing. The laundry facilities were not examined at this inspection. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The quality in this outcome group is adequate. The home ensures that the numbers of staff on duty are reflective of the needs of service users. Staff morale is good and staff turnover is low. This has a positive outcome for service users. Staff training is adequate and further training is planned. The home’s procedures for staff recruitment require some improvement. EVIDENCE: Staff spoken with at this inspection stated that they liked working at Chatham House and felt well supported. Staff morale appeared good. Staff turnover is low. This is positive for service users. The inspectors were informed that during the morning there were 5 care staff on duty, this reduces to between 3 and 4 in the afternoon and 3 in the evenings. Nights are covered by 2 waking staff. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 23 During this inspection, no concerns were raised by staff or service users regarding the numbers of staff on duty. Service users spoken with informed the inspectors that their needs were being met. Through discussion with staff, it was apparent that they had a good understanding of the needs of service users. In addition to the care staff, the home employs kitchen staff, domestics and 2 maintenance/gardeners. Mrs Pope and her daughter Ms Hall provide management support in addition to the care hours. Both live locally and spend much of their time at the home. The inspectors were informed that of the 22 care staff employed, 6 have achieved an NVQ level 2 or above. This equates to 27 . This is below the National Minimum Standards of 50 . A recommendation has been raised. The home’s procedures relating to staff recruitment were examined. Although two written references had been received, dates indicated that they had been received after the staff member had commenced employment. This was discussed with the provider/manager Ms Hall at the time. Ms Hall stated that telephone references had been obtained but there was no documented evidence to support this. The inspectors recommended that the home develops a suitable form for documenting telephone references and it was emphasised that telephone references did not replace written references. Enhanced CRB and POVA checks were seen in the recruitment files examined. There was evidence in the recruitment files examined that staff had received a four-day induction programme on commencing employment. Records relating to staff training indicated that staff had received up to date mandatory training. The provider/manager informed the inspectors that she had applied for staff training in dementia, diabetes and the protection of vulnerable adults. Progress will be followed up at the next inspection. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 24 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, 34, 35, 36, 37 and 38 The quality in this outcome group is adequate. The home is managed by a manager who has a wealth of experience and sound knowledge of the needs of the service users. The home’s quality assurance systems have improved and are being further developed. The home is in the process of improving systems for staff supervision. The home takes appropriate steps to ensure the health and safety of service users, staff and visitors, though would benefit from further improvements. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 25 EVIDENCE: Mrs Pope has owned and managed Chatham House since 1983 and has considerable experience in caring for the elderly. Mrs Pope qualified as Registered Nurse and practised for some time before opening the home. At this inspection, Mrs Pope advised the inspectors that she has not yet completed an appropriate management qualification, as set out in the National Minimum Standards. It should be pointed out that the scoring of ‘2’ (standard almost met) at the end of this report for standard 31, does not reflect Mrs Pope’s ability to manage the home, merely that the standard has not been fully met. Mrs Pope and her daughter Ms P Hall manage the home on a day-to-day basis. During this inspection, both demonstrated a good knowledge of the needs of the current service users and of their commitment to ensuring that service users feel that Chatham House is their home. Since the last inspection, the home has developed quality questionnaires, which were sent out to service users and their representatives. Comments regarding the care received and life at the home were positive. The home needs to ensure that regular meetings are held for service users and staff. Records should be maintained. This was acknowledged by the provider/manager who stated that a staff meeting was in the process of being arranged. Progress will be followed up at the next inspection. Some service users indicated that their views are sought on a daily basis. The home displays appropriate employers liability insurance, which expires 26/01/07. The provider/manager supplied the inspectors with information which indicated that the home does not manage any monies on behalf of service users. Annual appraisals are completed for all staff though the home is not currently recording staff supervision sessions. This was discussed at the time and progress will be followed up at the next inspection. In line with the National Minimum Standards, staff supervision sessions should take place at least 6 times a year. At the time of this inspection, all records examined were found to be appropriately stored in line with the Data Protection Act 1998. A tour of the premises was carried out and the following records were examined relating to Health and Safety; Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 26 FIRE SAFETY – The home’s fire risk assessment was not seen at this inspection. The home maintains records relating to weekly in-house tests on the home’s fire detection and fire alarm systems. Monthly checks are made on the emergency lighting systems. Annual servicing is carried out by an external agency on all fire detection and fire fighting equipment. This was last carried out in February 2006. All staff have received up to date training in fire safety. ELECTRICAL SAFETY – Portable appliance testing was found to be up to date. Appliances were last checked on 20/06/06. The home has an up to date Electrical Hardwiring Certificate and has recently had parts of the home completely rewired. This will continue throughout the home. ACCIDENTS – The home maintains appropriate records for accidents. The provider/manager informed the inspectors that she examines service user accidents monthly to ascertain whether there are any traits. Findings are not formally documented. The numbers of accidents recorded were low. COSHH – At the time of this inspection, all cleaning materials and items hazardous to health were found to be appropriately stored. HOT WATER OUTLETS – The inspectors were informed that all bath hot water outlets had been fitted with a thermostatic control. Warning signage was in place over wash hand basins. Bath hot water outlets checked at this inspection were within the HSE recommended upper limits. To ensure that bath hot water outlets do not exceed 44C, it has been recommended that the home records monthly checks on all outlets. To ensure the safety of service users, radiators are guarded, wardrobes are secured to the wall and upstairs windows are fitted with a restrictor. The home must ensure that daily temperatures are recorded for the fridge and freezer in the kitchen. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 27 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 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 3 3 2 3 2 Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 28 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 OP7 Regulation 15(1) & (2) Requirement The registered person must update the home’s care planning systems to ensure that the assessed needs of service users are clearly identified and that there are clear instructions for staff on how needs should be met. Care plans should promote a person centred approach to care and be reviewed at least monthly. The registered person must ensure that appropriate and up to date assessments are maintained for service users. The registered person must ensure that two satisfactory references are received prior to staff commencing employment. Details of telephone references should be recorded. The home must ensure that daily temperatures are recorded for the fridge and freezer in the kitchen Timescale for action 10/11/06 2 OP8 14(1)(a) & 14(2) 19(1) 10/11/06 3 OP29 13/09/06 4 OP38 13(4) 25/09/06 Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 29 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 Refer to Standard OP9 OP9 OP12 OP28 OP38 Good Practice Recommendations The registered person should ensure that hand transcribed entries on service user Medication Administration Records (MAR), are confirmed by two staff signatures. The registered person should ensure that any creams in use for service users are identified with the open/expiry date as they have a limited shelf life once opened. The registered person should maintain individual records relating to activities offered. This should also include the outcome for service users. In line with the NMS, the registered person should aim for a minimum of 50 of the care staff having achieved an NVQ Level 2 or equivalent. To reducing the risk of scalding, monthly checks should be carried out on all hot water outlets to ensure that they do not exceed HSE recommended upper limits. Records should be maintained. Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Chatham House DS0000015985.V306213.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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