CARE HOMES FOR OLDER PEOPLE
Chatsworth House 9 Belvedere Road Redland Bristol BS6 7JG
Lead Inspector Sandra Gibson Unannounced 13July 2005 1.15pm 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 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. Chatsworth House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Chatsworth House Address 9 Belvedere Road Redland Bristol BS6 7JG 0117 9743253 0117 9743238 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) B and C Care Limited Helen Jane Fuller PC Care Home 15 Category(ies) of DE Dementia registration, with number DE(E) Dementia - over 65 of places (15) Chatsworth House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Residents must be aged 50 or over. Date of last inspection 22 November 2004 Brief Description of the Service: Chatsworth House is a priavately owned Care home that is registered by the Commission for Social Care Inspection to provide accommodation and personal care for up to 15 people aged 50 and over who have dementia. It is situated in a residential area close to Durdham Downs in Westbury Park and can be accessed by car or bus. The home is a converted older property providing single room accommodation on three floors, which can be accessed via stairs or a passenger lift. There is one shared room. Five bedrooms have ensuite facilities. The home is situated in its own grounds with a courtyard to the rear. Visitors are welcome at any time and refreshments are readily available. Inhouse activities and entertainments are also provided. Chatsworth House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Wednesday between the hours of 1.15pm and 5.15pm. Evidence was gathered from: Talking to and observing residents, talking to the manager and two of the three company directors, talking to and observing staff, observing communal evening meal, looking at the premises, examining records and policies and procedures. What the service does well:
People moving to Chatsworth House can be sure that their needs can be adequately met. Care plans and individual risk assessments are of a good standard ensuring that residents’ needs are fully identified and met. The health care needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis. The residents of Chatsworth House are given the opportunity to experience a stimulating and varied life where various informal activities and outings have been regularly made available. Visitors are made very welcome and meals are well managed and provide daily variation, good nutrition and social contact for people. Residents and their relatives are confident that their concerns will be listened too and have been made aware of the complaints procedure. The home is managed efficiently by an experienced manager and the majority of records were up to date and accurate so that resident’s best interests and health and safety are protected. Support to care staff is good with the establishment of regular staff meetings and formal supervision which ensures that staff are appropriately supervised and kept up to date about residents needs. Chatsworth House Version 1.10 Page 6 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Chatsworth House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Chatsworth House Version 1.10 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 standard(s) 1,2,3,4,5 Standard 6 is not applicable in this care home Information provided to prospective residents was not wholly accurate and could be misleading. People moving to Chatsworth House can be sure that their needs can be adequately met. EVIDENCE: The statement of purpose has been further developed. However, gaps in the information required by the legislation were noted. These gaps included the information qualifications and experience of the registered individuals, the age range of residents and gender and the criteria for admission. The inspector noted that the care home is registered to accommodate and provide personal care to residents who have dementia and are fifty years and over. The manager was not aware of this age range and informed the inspector that the care home currently provides care to residents who are sixty-five years and over and that they may not be able to meet younger residents needs ie (50 years –59 years). However, the manager indicated that depending on residents needs it may be possible to provide personal care to a small number of residents aged 60 years and over. Chatsworth House Version 1.10 Page 9 The new service user’s guide was examined and it was pleasing to see that the manager had taken care to use plain English and photographs of residents and staff to make it more accessible to residents and their relatives. The inspector observed however that there were also a few gaps in the information required in this document. The inspector observed a sample of needs assessments completed prior to residents admission. It was noted that these had been completed by Social services and Health or by the manager in the case of privately funded residents. All assessments were found to be of a good standard. Residents admitted to the home have the opportunity to have a formal review with the support of their relatives within 4-6 weeks to ensure that the quality, facilities and suitability of Chatsworth House meets theirneeds. Chatsworth House Version 1.10 Page 10 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 standard(s) 7,8,9,10 Care plans and individual risk assessments are of a good standard ensuring that residents’ needs are fully identified and met. The health care needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis. However, it was noted some of the the medication administration records were poor and potentially put residents at risk. EVIDENCE: A sample of care plans and risk assessments were seen and it was observed that they were very clear well detailed and there that there was evidence in place to confirm that they were reviewed on a regular basis by the manager in consultation with the resident and their representative where possible. Chatsworth House Version 1.10 Page 11 District nurse and chiropodists are contacted at the appropriate time. Equipment was observed to be in place to prevent pressure sores in residents who were at risk. There was one gap in the medication administration records and one sign of confused recording where it was unclear whether a resident was prescribed medication to be given at night or in the evening. Chatsworth House Version 1.10 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 standard(s) 12, 13,14,and 15 The residents of Chatsworth House are given the opportunity to experience a stimulating and varied life where various informal activities and outings have been regularly made available. Visitors are made very welcome and meals are well managed and provide daily variation, good nutrition and social contact for people. EVIDENCE: There is an activities Coordinator in post who works Monday to Friday during the hours of 8.30am and 3.30pm. There was evidence in place to confirm that a variety of activities take place throughout the week with individual residents or groups of residents. However, It was noted that the activities coordinator has recently been helping with the cleaning duties as there is no domestic assistant in post at present. The manager explained that she was monitoring the situation closely and that residents were not currently affected by this change in role as the cleaning would take place when the residents were resting or watching a video or TV in the afternoon. The inspector heard about the monthly outing which had been to Weston–super-Mare the week before the inspection. Other recent outings included a trip to Longleat and a trip to see Cinderella on Ice at Cheltenham.
Chatsworth House Version 1.10 Page 13 All residents observed during the inspection looked relaxed with the staff providing their care who were observed to respond to the residents in a respectful unhurried manner. Residents consulted told the Inspector that “I like it here, they treat me very well” The inspector observed residents enjoying their evening meal which consisted of a choice of sandwiches and a piece of cake. One resident said “The staff are lovely and the food is good”. Another said “the food is tasty and well made”. One resident told the inspector that she had been asked to be a representative of the residents’ meetings. She said that she felt very honoured to be in that position, but confirmed that she enjoyed having the opportunity to raise any issues with the manager on behalf of the other residents. The inspector noted that relatives’ social evenings are held every three months to which all relatives carers and friends are invited. Chatsworth House Version 1.10 Page 14 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 standard(s) 16,18 Residents and their relatives are confident that their concerns will be listened too and have been made aware of the complaints procedure. Arrangements for protecting residents from harm has improved considerably during the last year but further work needs to take place to protect residents from possible risk or harm. EVIDENCE: Residents, and staff told the inspector that they were comfortable talking to the manager or one of the management team about any concerns. Residents were seen actively seeking out the members of the management team on duty that day with any concerns they had. No complaints have been received either by the manager, or The Commission for Social Care Inspection since the last inspection. No Secrets in Bristol (Local authority Adult Protection procedure) is in place in the home. The manager and the deputy manager have recently attended training provided by Social Services and health on adult protection. However, the inspector noted that there was a lack of familiarity by some of the management team of what to do when an adult protection allegation was made. It was also noted that no other member of staff had attended adult protection training. Chatsworth House Version 1.10 Page 15 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 standard(s) 19,20,21,22,23,24,25,26 A comfortable, clean, safe standard of accommodation and court yard is currently provided for the residents of Chatsworth House, but the arrangements to maintain this standard must be further improved to ensure a satisfactory standard at all times EVIDENCE: The manager informed the inspector that the domestic assistant left three months ago and that they are currently in the process of appointing a new member of staff. The lack of this ancillary support has put a strain on the staff team as the activities coordinator is currently fulfilling this role as well as carrying out her own job as discussed earlier in the report. The care was observed to be reasonably clean and there were no unpleasant odours noted when the inspector was touring the communal areas and a sample of bedrooms. Chatsworth House Version 1.10 Page 16 Residents’ bedrooms looked homely and were personalised with residents’ personal possessions and furniture. There are plans in place to extend Chatsworth House which if agreed would increase the number of residents by six. The inspector also noted that it may reduce the courtyard area at the rear of the property which the residents currently have access to. Chatsworth House Version 1.10 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Staffing levels have improved since the last inspection, but they need to be improved further to ensure that they meet the residents needs at all times. The procedures for the recruitment of staff are not robust and do not provide the safeguards to offer protection to people living in the home. Staff are on the whole trained and competent to do their job, but training provided to staff must be further improved to ensure that all residents’ individual needs, physical and mental health needs are met. EVIDENCE: Staffing levels have improved slightly since the last inspection when a requirement was made for staffing levels to be adequate at all times. This inspection took place on a Wednesday afternoon and it was it was observed that the staffing levels were adequate. However, the inspector noted from the staff rota in June that staffing levels were low particularly on a Friday morning when sometimes only two members of staff were available to assist residents to get up, make residents breakfast give out breakfasts and support residents. Chatsworth House Version 1.10 Page 18 The inspector noted that this situation improved in July with three members of staff on each morning shift and three on an afternoon shift. However, it was noted that the third member of staff was the cook and not a care assistant. As discussed earlier there has been no domestic assistant in June or July 2005. The inspector noted that the staff rota was confusing to read as no indication of staff members job title was noted. Consequently, the staffing levels may look satisfactory, but this may be as a result of the cook being on duty. Ancillary staff must be extra to care staff at all times. The inspector examined a sample of staff personnel files. It was observed that one new member of staff had a number of gaps in the information held on her personnel file including: no evidence of any relevant qualifications, no declaration of physical and mental health fitness, and no references. There is a programme of internal statutory training which includes basic food hygiene, first aid, and manual handling. It was noted the manager, deputy manager and responsible individual have completed training for trainers in these subjects which enables them to provide training to all the care staff in the home. The manager informed the inspector that the staff team are currently still working towards 50 of all care staff obtaining NVQ2 and hoped to reach this national minimum standard by December 2005. It was pleasing to hear that the Deputy manager has completed NVQ 3 and is currently undertaking the Registered managers’ award . Communication between residents and staff was noted to be very good and all staff observed were very sensitive to residents’ needs and spoke to residents with respect and an awareness of their dignity. However, the inspector saw no evidence of specialist training in this care home for care staff which included dementia care training, mental health training and loss and bereavement. Chatsworth House Version 1.10 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36,37,38 The home is managed efficiently by an experienced manager and the majority of records were up to date and accurate so that resident’s best interests and health and safety are protected. Support to care staff is good with the establishment of regular staff meetings and formal supervision which ensures that staff are appropriately supervised and kept up to date about residents needs. Residents’ financial records are well maintained but the environment arrangements need to be improved to ensure the security of residents and staff records in order to protect this information. Chatsworth House Version 1.10 Page 20 EVIDENCE: The manager has several years experience of managing Chatsworth House. She also has an NVQ4 in Management of Care Services. There was written records to confirm that she regularly updates her knowledge and skills. The majority of records, policies and procedures examined were up to date except those already discussed in the report. All staff consulted felt well supported and confirmed that they had regular team meetings and supervision. An external financial auditor visits the home on regular basis. There are arrangements in place to hold secure any finances held for residents. However it was observed that environmental security arrangements for keeping records needs to be improved. Chatsworth House Version 1.10 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 3 3 3 3 2 3 Chatsworth House Version 1.10 Page 22 yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4 Requirement Timescale for action 15th October 2005 15th October 2005 15th October 2005 2. 1 3. 1 4. 5. 9 18 6. 27 The Statement of Purpose must be further developed to include all gaps in information as outlined in Schedule 1 5 The service users guide must be further developed to include all gaps as outlined in National Minimum Standards 1 Registrati The registered person must on formally write to the CSCI to Regulation request a variation of the age 2001 range from 50 to 60 years to Sch12 ensure that service users needs can be met at all times 13(2) Medication administration records must be accurately maintained at all times 13(6) The manager must attend the training for managers/providers in Adult Protection and all members of staff must attend the Adult protection awareness training provided by Bristol Social Services and Health 18(1)(a) The manager must provide a detailed staff rota showing which members of staff are on duty and in what capacity they are working 15th September 2005 31st December2 005 15th October 2005 Chatsworth House Version 1.10 Page 23 7. 27 18(1)(a) 8. 27 18(1)(a) 9. 29 Sch (2) 19 10. 30 18(1)(c ) 11. 12. 37 23(2)(1) The manager must ensure that residents dependency levels are met at all times by ensuring that additional care staff are available at peak times when required Domestic staff must be employed in sufficient numbers to ensue that standrads relating to food, meals and the home is maintained in a clean hygenic state. These staff members must be extra to care staff at all times . The fitness of all staff must be demonstated before they are employed. This includes details of physical and mental health, two satisfactory written records and evidence of staff members experience. This information must be held on file and made available for inspection Specialist training must be provided to all care staff.This must include dementia care, working with residents with mental healthneeds and loss and bereavement The environmental security arrangements must be improved 15th October 2005 15th October 2005 15th September 2005 31st December 2005 15th October20 05 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 Good Practice Recommendations Chatsworth House Version 1.10 Page 24 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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