Inspection on 31/07/07 for Chatham House

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 13/09/06

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 Unannounced Inspection 31st July 2007 09:30 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.V339149.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chatham House DS0000015985.V339149.R01.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 F/P 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.V339149.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 2006 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. The home’s current fee range is between £370 & £390 per week. Additional charges include: chiropody, personal toiletries, hairdressing, newspapers/magazines and some personal care products. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The home’s last key inspection was conducted on 13th September 2006. A further unannounced inspection was carried out on 28th February 2007 to follow up on requirements made. This key unannounced inspection was carried out over one day (13 inspector hours) by CSCI Regulation inspectors Kathy McCluskey and Shelagh Laver. When the inspectors arrived at the home, the registered person and deputy were not available. Both arrived soon after they were contacted by staff. Both remained at the home throughout the inspection. At the time of this inspection 22 service users were living at the home. The inspectors were able to speak to fifteen service users during this inspection. Two staff were spoken with. As part of this key inspection, the Commission sent comment cards to service users, relatives and healthcare professionals Eight have been received from service users, four from relatives and three from GP’s. Comments received have been incorporated throughout this report. The inspectors were given unrestricted access to the home. A selection of bedrooms and communal areas were seen. Records relating to service users, staff and health and safety were examined. The inspectors would like to thank service users, staff and the management team for their time and co-operation with the inspection process. The following is a summary of the report and should be read in conjunction with the whole of the report. What the service does well: Chatham House provides service users with a clean and homely environment. Service users can choose how and where to spend their day. Some comments received from service users included; ‘You can’t fault it’, ‘I go to bed when I like and I get up when I like’, ‘I choose how to spend my day’ Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 6 Information about the home is available and prospective service users are assessed to ensure that their needs can me met. Prospective service users are given the opportunity to ‘test drive’ the home prior to making a decision to live there. Service users commented on the kindness of staff and confirmed that they were treated with respect. ‘The staff are lovely’, ‘You can always talk to them or Joan’ (Joan is the registered person). Staff informed the inspectors that they ‘really enjoyed working at the home’. The home has a stable staff team and has not had to use agency staff. A GP commented; ‘A very caring home’ What has improved since the last inspection? 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 Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Service users and their representatives are provided with the information they need to enable them to make an informed choice about moving to the home. The home takes appropriate steps to ensure that the needs of prospective service users can be met. EVIDENCE: The home has a Statement of Purpose, which the inspectors were informed, is contained within the home’s brochure. The registered provider/manager informed the inspectors that there have been no changes to these documents since the last inspection. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 10 Care plans examined contained evidence that prospective service users had been assessed prior to a placement being offered. Assessments were also available from other healthcare professionals. Prospective service users and/or their representatives are encouraged to visit the home prior to making a decision to move there. As part of this key inspection, the Commission sent comment cards to service users and relatives. Eight completed comment cards were received from service users and six confirmed that they had received enough information about the home before moving there. One commented that they ‘stayed for two weeks to try it’, another stated that their ‘relative made all the arrangements’. During this inspection the inspectors spoke with fifteen service users and five stated that their relatives had visited the home on their behalf. Six comment cards were received from relatives and five confirmed that they were provided with sufficient information about the home. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home’s care planning systems require improvement. Service users are registered with a GP but the home needs to maintain appropriate records relating to contact with healthcare professionals. The home’s procedures for the management and administration of service users medication requires improvements. Service users confirmed that they were treated with respect and that their privacy was respected. EVIDENCE: The inspectors examined two service user care plans in detail at this inspection and were unable to see evidence that the requirement raised at the last two inspections had been addressed. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 12 Care plans did not promote a person centred approach to care. Care needs had not been clearly identified and did not provide staff with detailed information as to how individual’s assessed needs should be met. The inspectors found that a care plan supplied by a healthcare professional when the service user had moved to the home, had not been reflected in the care plans raised by the home. Following discussion with the registered provider/manager, the inspectors were informed that further information could be found in the ‘day book’. The inspectors discussed the need to ensure that service user care plans contain all appropriate information and that staff should use care plans as ‘working plans’. The use of additional recording methods should be reviewed to ensure that all information pertaining to service users is up to date, reflective of needs and easily accessible. All service users are registered with a GP but the home is not currently recording the individuals’ contact with healthcare professionals in the service users care plans. It has been required that action is taken to address this. In completed comment cards for the Commission, five service users responded ‘Always’ to the question ‘Do you receive the medical support that you need’. One responded ‘usually’. Two relatives indicated that they were ‘always’ kept up to date with important medical issues’ The home monitors service users weights on a monthly basis and records are maintained. Eight service users completed comment cards for the Commission and in response to the question, ‘Do you receive the care and support you need’, six responded ‘Always’ and two ‘usually’. Two relatives responded ‘usually’ to the question. Three comment cards were received from GP’s. All confirmed that the home communicated clearly with them and that staff demonstrated a clear understanding of the care needs of service users. All confirmed that they were satisfied with the level of care provided to service users in the home. One GP described the home as , ‘Very caring’. All service users spoken with at this inspection informed the inspectors that they felt that the home was able to meet their needs. No concerns were raised and service users stated that they would raise concerns if they had any. Service users commented on the kindness of the staff and of the registered provider/manager. Six care staff completed comment cards for the Commission and three confirmed that they were involved in care planning. Five confirmed that they were clear what duties they must not undertake. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 13 The inspectors spoke with two staff at this inspection and both confirmed that they experienced no problems in meeting the of the service users currently living at the home. The inspectors examined the home’s procedures for the management and administration of service users medication. The home uses the Boots monitored dosage system (MDS) with pre-printed medication administration charts (MAR). Medicines were seen to be securely stored. MAR charts were examined and the inspectors noted that on four occasions, hand written entries had not been confirmed with staff signatures. To reduce the risk of errors, it has been recommended that any hand transcribed entry on MAR charts is confirmed with two competent staff signatures. On one chart, for a medicine prescribed with a variable dose, it was noted that the actual numbers of tablets administered was not always recorded. These shortfalls were identified and discussed with the registered provider/manager at the time of the inspection. The home has lockable fridge for the storage of medicines though the inspectors were informed that there were currently no medicines requiring refrigeration. The inspectors were also informed that no service users were currently prescribed controlled medicines. The registered provider/manager informed the inspectors that only senior staff were involved in the management and administration of service users medication and that they had received training. The inspectors looked at training records for seven staff at this inspection. These identified that three of the seven staff had received medication training in 2004. It has been recommended that the registered provider/manager sources appropriate training for staff to ensure that they remain updated. It has also been recommended that the home maintains a list of the staff responsible for the management and administration of service user medication. The list should be kept with the MAR charts and contain each staff members signature and initials. All service users spoken with at this inspection confirmed that they were treated with respect and that their privacy was respected. Suitable locks are fitted to bedroom doors and each bedroom is fitted with lockable space for service users. Service users informed the inspectors that ‘staff were kind and helpful’. Chatham House DS0000015985.V339149.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can choose how to spend their day though the provision of activities requires improvement. The home welcomes visitors at any reasonable time in accordance with the wishes of service users. The menu requires review. EVIDENCE: The home does not currently produce a programme of activities for service users. The inspectors were informed by the registered provider/manager that activities are decided on a ‘day to day’ basis and would be determined by what the service users wanted to do. Feedback from service users was varied. Some stated that they could play cards, do board games and quizzes, others said that ‘there’s not much going on’. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 15 Service users did confirm that there were mini-bus trips twice a week. Places visited included trips to Weston-Super-mare, Burnham-on-Sea and the Quantocks. A planned trip took place on the afternoon of the inspection. A hairdresser visits the home once a week. The home is in the process of obtaining social history’s from service users. Of the eight comment cards received from service users, responses to the question, ‘Are there activities arranged by the home that you can take part in’, two responded ‘Always’, five ‘Usually’ and one ‘Sometimes’. A comment from relatives in response to ‘How do you think the home can improve?’ was ‘more social activities’ and ‘more exercise’. On the morning of the inspection, the majority of service users appeared to be utilising the large lounge area. Some were watching the television, some were reading the daily newspapers and some were enjoying a chat with another service user. The atmosphere was relaxed and service users confirmed that they could choose how and where to spend their day. The inspectors met with one service user who had chosen to remain in their bedroom to listen to a ‘talking book’. Service users confirmed that they could choose what time to go to bed or get up in the morning. During the afternoon, some service users had gone on the mini-bus trip, others were in the lounge or had chosen to return to their bedrooms. One service user was in the garden. It has been required that after consultation with service users, the home devises a planned programme of activities for service users which will enable them to make an informed choice about whether they choose to participate or not. The inspectors also discussed the need to maintain records for each service user as this would provide useful feedback from individuals relating to the activity offered. This was also recommended at the last inspection. Service users confirmed that their relatives ‘could visit when they liked’ and were ‘always made to feel welcome’. No relatives were seen at this inspection. All meals are prepared and cooked at the home. The home has a spacious dining room and the inspectors noted that tables had been attractively laid for lunch. Condiments and paper napkins were available on each table. On arrival at the home at 0935hrs, service users were in the dining room having breakfast. Service users informed the inspectors that they could ‘have what they liked’ Many chose porridge and toast. Comments about the main meal were mixed; ‘It’s all right’, ‘Would like more variety’ ‘Less sausages and corned beef’. On the day of the inspection, lunch was observed being served. The meal was sausages, mashed potato, cabbage and gravy. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 16 None of the service users spoken with knew what was for lunch and were not aware of a menu. None of the service users were aware that they could have an alternative choice at lunch time. This was discussed with the registered provider/manager who informed the inspectors that a menu was in a book in the dining room. As the home does not have meetings for service users, it has been recommended that the days menu is displayed in a more prominent position for service users. Eight service users completed comment cards for the Commission. In response to the question, ‘Do you like the meals at the home’, five responded ‘Usually’ and one ‘sometimes’ and one ‘Always’. Copies of a four week menu were made available to the inspectors. The registered provider/manager informed the inspectors that meals on the menu had been chosen by service users. On examination of the menus, it has been required that the home review the main meal options and seeks the advice of a dietician as some of the meals did not appear to be sufficiently wholesome for older people. Some examples of these main meals include; corned beef hash & greens, fish cakes & runner beans, quiche & chips, egg & chips, baked potato & salad, cauliflower cheese, bacon, egg & mushrooms. It should be pointed out that on three days, meals appear more wholesome and include things like roast, shepherds pie and chicken casserole. Throughout the day, drinks for service users were observed to be plentiful. Chatham House DS0000015985.V339149.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home’s complaints procedure is insufficient and requires improvement. The home’s procedures relating to abuse require improvement. EVIDENCE: The home does not have a clear complaints procedure in the home. A file is maintained in the reception area of the home though information provided is insufficient. The home must ensure that a clear complaints procedure is developed which includes timescales for action and the contact details of the Commission for Social Care Inspection. Service users spoken with during this inspection informed the inspectors that they would speak to a member of staff or the registered provider/manager if they had any concerns. Six of the eight comment cards received from service users confirmed that they knew who to speak to if they were not happy. In response to the comment card question, ‘Do you know how to make a complaint’, all eight service users responded ‘Yes’. Four relatives returned comment cards to the Commission and in response to the question, ‘Do you know how to make a complaint’ Two responded ‘Yes’, one ‘No’ and one ‘I don’t remember’ Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 18 The registered provider/manager informed the inspectors that the home had not had any complaints. No concerns have been raised directly with the Commission. The home needs to ensure that its’ policies and procedures relating to abuse and the protection of vulnerable adults is up to date. The registered provider/manager was provided with information on how to obtain a copy of the revised policy ‘Somerset Safeguarding Adults Policy and Procedure’ May 2007. The inspectors were informed that ‘abuse training’ was currently being arranged for staff. The registered provider/manager also advised the inspectors of this at the last inspection. A requirement has been raised. Chatham House DS0000015985.V339149.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and homely environment. Bedrooms are comfortable and service users can personalise their rooms. The standard of cleanliness in the home is good. EVIDENCE: 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 promotes a ‘homely’ feel which was also confirmed by service users spoken with. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 20 The home has a range of communal space, which include a very spacious lounge which has patio doors and views over the garden. This lounge is arranged into three distinctive areas. The majority of service users were seen to be utilising this area on the day of the inspection. A smaller lounge is also available. There is a good-sized dining room which looks out at the front of the house. The home has interesting and extensive gardens to the rear, which are accessible to wheelchair users. Ramps and grab rails are appropriately sited. Garden furniture is available and two service users informed the inspectors that they liked to sit in the garden when their relatives visited. Car parking is available at the front of the property. Grab rails and ramps are appropriately sited. A nurse call system is installed in all bedrooms and communal areas/facilities. Service users spoken with confirmed that call bells were answered promptly. 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. Service users spoken with informed the inspectors that they liked living at Chatham House and were very satisfied with their bedrooms. A selection of bedrooms were seen at this inspection. All were pleasant and comfortably furnished. One service user informed the inspector that, at her request, she was in the process of moving rooms. At the time of this inspection, one bedroom was in the process of being completely refurbished. 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. The home has an assisted communal bath and level access shower in addition to en-suite facilities. As required, service users have their own mobility aids/wheelchairs. The home has one mobile hoist and one stand-aid. 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. On the day of this inspection the home was clean and free from malodours. Hand washing facilities are appropriately sited in the home. Staff have access to protective clothing. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 21 The laundry facilities were not examined at this inspection. Chatham House DS0000015985.V339149.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staffing levels at the home are adequate and currently meet the needs of service users. Staff recruitment procedures are generally good though further improvements are required. The home’s records do not confirm that staff are appropriately trained or competent to do their jobs. EVIDENCE: The inspectors were informed that there were currently no staff vacancies at the home and the home does not use agency staff. The inspectors were informed that staffing levels at the home were as follows: Mornings – 4 care staff Afternoon/evening – 3 care staff Nights – 2 waking care staff. The registered provider/manager stated that a senior member of staff is on duty at all times and is responsible for administering medicines. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 23 The inspectors were also informed that the registered person is on-call out of hours and is often at the home during the evening/night. The registered person is supported by her daughter who is the deputy. It could not be ascertained how much time they are at the home and it has been recommended that their hours are clearly identified on the duty rota. Six staff completed comment cards for the Commission and five confirmed that there was ‘always a senior member of staff to confer with’. Two staff were spoken with at this inspection and no concerns were raised regarding staffing levels at the home. During the inspection the inspectors noted a good staff presence. Eight service users completed comment cards for the Commission and in response to the question, ‘Are the staff available when you need them’, four responded ‘Always’ and four ‘Usually’. Four comment cards were received from relatives and one comment was that there were ‘not always enough staff to supervise those in need and a lack of experienced senior staff on duty’. Two GP’s commented that there was not always a senior member of staff to confer with. Two staff have been recruited since the last inspection and the inspectors were able to examine these recruitment files. Both contained evidence of a criminal records check (CRB) and Protection of Vulnerable Adults check (POVA). In one file, only one written reference was available. The registered provider/manager informed the inspectors that it had been received but was returned after it was addressed ‘to whom it may concern’. A requirement has been raised. Filing systems for staff recruitment files should be reviewed as they appeared disorganised and it was difficult to locate information. The home has an induction programme for staff, which should be reviewed to ensure that it meets with the Skills for Care Common Induction Standards. One recently appointed carer had not completed an induction programme and the inspectors were informed that this was because they had ‘worked at the home before’. The registered person must ensure that all staff receive appropriate induction and training on commencement of employment. It was difficult for the inspectors to ascertain staff training achievements/needs given the home’s recording systems. Some certificates were available for staff though the check list used by the home did not clearly identify the date of training or when refresher training would be due. This was discussed at the time. On examination of certificates, the inspectors noted that some mandatory training was out of date. According to records examined, some staff had not Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 24 received moving and handling training since October 2005, this was also the case for fire training. Medication training last took place in 2004. It appeared that in 2006 & 2007, no staff training took place. The inspectors were able to see that some staff had achieved an NVQ level 2 in care. It was difficult to establish how many staff had achieved or were working towards this award. The Registered Manager stated that all staff, except the two recently appointed were up-to-date with First Aid training A requirement has been raised (refer to Standard 38) Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36 & 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home does not have systems in place to formally seek the views of service users. Staff are not appropriately supervised and have not had up to date mandatory training. The home’s procedures relating to health and safety require improvements. EVIDENCE: Mrs Pope has owned and managed Chatham House since 1983 and has considerable experience in caring for the elderly. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 26 Mrs Pope informed the inspectors that she was an NVQ assessor and had recently completed the registered managers award and was awaiting results. Documented evidence was not examined at this inspection. Mrs Pope is supported by her daughter Ms P.Hall. Service users and staff spoken with confirmed that they found the registered provider/manager ‘very approachable’ and that they ‘could always talk to her’ In April of this year, the home has sent out quality questionnaires to relatives. A selection were examined at this inspection and comments were very positive. The registered person stated that the views of service users are sought on a ‘day to day’ basis and that no formal systems were in place to seek their views. The inspectors were informed that the home were ‘trying to do two staff appraisals a year and staff meetings’ No evidence of staff meetings or supervision were made available to the inspectors at this inspection. A requirement has been raised. The inspectors were informed that the home was not currently managing any money on behalf of service users. Each bedroom has been provided with lockable facilities for service users. The home displays up to date employers liability insurance which expires in January 2008. The homes records were examined relating to health & safety. A tour of the premises was also carried out. FIRE SAFTY – Records demonstrated that in-house weekly checks were made on the home’s fire alarm systems. Emergency lighting is tested monthly. Fire equipment was last serviced on 09/02/07. As previously mentioned in this report, staff fire training was not up to date. A requirement has been raised. ELECTRICAL SAFETY – Annual servicing on the home’s portable appliances was found to be up to date. This was last recorded as June 2007. The home has an up to date electrical hard wiring certificate. EQUIPMENT SERVICING – Servicing records for the home’s passenger lift, stair lift and bath aids were found to be up to date. An immediate requirement was issued at the time of the inspection as servicing records for the two mobile hoists were out of date. These were last serviced in November 2006. In accordance with Health & Safety Executive Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 27 requirements, all equipment used for the transportation of service users must be serviced in accordance with LOLER regulations at least six monthly. 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. A recommendation has been raised. The registered person was unclear as to her reporting responsibilities under Regulation 37, Care Homes Regulations, and so was reminded to inform the Commission without delay, of any death, outbreak of infectious disease, any serious injury to a service user, any serious illness, any event which adversely affects the well-being or safety of a service user, any theft, burglary or accident in the home and any allegation of misconduct by the registered person or any person who works at the home. This refers to Regulation 37 of the Care Homes Regulations 2001. 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. As required at the last inspection, the home maintains monthly checks to ensure temperatures remain within safe limits. To ensure the safety of service users, radiators are guarded, wardrobes are secured to the wall and upstairs windows are fitted with a restrictor. As required at the last inspection, appropriate temperature records are now maintained for the home’s fridges and freezers. STAFF TRAINING – As previously mentioned in this report, mandatory training for staff was not up to date. This included moving and handling and fire. Also training in the management and administration of medication had not taken place since 2004. A requirement has been raised. Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 28 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 3 3 x 3 3 3 3 3 STAFFING Standard No Score 27 3 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 3 3 1 x 1 Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 29 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. Previous timescales of 10/11/06 & 01/05/07 not met 2. OP8 17(1)(a) The registered person must 01/09/07 maintain appropriate records relating to a service users contact with a GP or any other healthcare professional. The registered person must, 10/10/07 after consultation with service users and having regard for the needs of service users, develop a programme of activities in relation to recreation and fitness. After consultation with a 15/09/07 dietician, the registered person DS0000015985.V339149.R01.S.doc Version 5.2 Page 30 Timescale for action 01/10/07 3. OP12 4(1)(c) Schedule 1(9) &16(2)(n) 12(1)(a) & 16(2)(i) 4. OP15 Chatham House 5. OP16 22 6. OP18 13(6) 7. OP29 19(1) & schedule 2 (5) 18(1)(a & (c) 8. OP30 9. OP36 18(2) 10. OP38 13(4) & 23(4)(d)& (e) 13(4) & (5) 11. OP38 12. OP38 13(4) must devise a menu which provides wholesome and nutritious meals for service users The registered person must develop and display a clear complaints procedure which includes how and who will deal with complaints, timescales for action and the contact details of the Commission. The registered person must ensure that appropriate and up to date policies are available to staff relating to abuse/safeguarding adults and that staff are appropriately trained. The registered person must ensure that two satisfactory references are received for all staff before they commence employment. The registered person must take action to ensure that all staff receive induction and on-going training to ensure that they have the skills to meet the needs of service users. The registered person must make suitable arrangements to ensure that staff are appropriately supervised. Formal supervision sessions for staff should take place at least 6 times a year with records maintained. The registered person must take action to ensure that all staff receive appropriate and up to date training in fire safety. To ensure the health & safety of service users and staff, the registered person must make arrangements for staff to receive appropriate training in moving and handling. The registered person must take immediate action to ensure that DS0000015985.V339149.R01.S.doc 30/08/07 30/09/07 10/08/07 30/10/07 30/10/07 20/08/07 20/09/07 03/08/07 Page 31 Chatham House Version 5.2 the two mobile hoists are serviced in accordance with LOLER regulations and to ensure that service users are not placed at risk of injury. An immediate requirement was issued at the time of the inspection. The registered provider is required to provide evidence to the Commission, that this has been addressed by the date shown. The registered person is required to inform the Commission, without delay, of any incident listed in Regulation 37 of the Care Homes Regulations 2001. 13. OP38 37 10/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The registered person should review care need recording systems to ensure that all information pertaining to a service user is up to date and maintained within the service user care plans. The registered person should ensure that hand transcribed entries on service user Medication Administration Records (MAR), are confirmed by two staff signatures. This was raised at the previous two inspections. To ensure the well-being of service users, the registered person should ensure that the amount administered for variable dose medication is recorded. The registered person should maintain a list of staff responsible for the administration of medication. This should include a sample of their signature and initials. The registered person should ensure that all staff involved DS0000015985.V339149.R01.S.doc Version 5.2 Page 32 2. OP9 3. 4. 5. OP9 OP9 OP9 Chatham House 6. OP12 in the management and administration of service user medication receive appropriate up to date training. The registered person should maintain individual records for service users relating to activities offered. This should also include the outcome for service users. This was also recommended at the last inspection. The registered person should ensure that the days menu is displayed for service users in a prominent position. The registered person should ensure that their working hours and those of the deputy manager, are clearly identified on the staff duty rota 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. Not assessed – this was raised at the last inspection. To ensure that staff are appropriately trained, the registered person should ensure that the staff induction programme is reviewed in line with the Skills for Care Common Induction Standards. The registered person should ensure that a training matrix is devised which will clearly identify the training achievements and needs of staff. The registered person should introduce systems to seek the views of service users. The registered person should give serious consideration to developing an analysis of accidents so that any traits can be identified and action taken as appropriate. 7. 8. 9. OP15 OP27 OP28 10. OP30 11. 12. 13. OP30 OP33 OP38 Chatham House DS0000015985.V339149.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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