Inspection on 14/03/07 for Chatsworth House

This inspection was carried out on 14th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Chatsworth House 17/12/09

Chatsworth House 28/01/09

Chatsworth House 25/01/08

Chatsworth House 09/06/06

Chatsworth House 27/02/06

Chatsworth House 13/07/05

Chatsworth House 22/11/04

Chatsworth House 30/07/04

Chatsworth House 31/01/04

Similar services:

Fairfields Country Rest Home

Fairfax House

Claremont Nursing Home

Doveridge Care Home

Dunmore

Chatsworth

Dunraven Lodge

Eastleigh Care Homes, South Molton

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

CARE HOMES FOR OLDER PEOPLE Chatsworth House 9 Belvedere Road Redland Bristol BS6 7JG Lead Inspector Sandra Gibson Key Unannounced Inspection 14th March 2007 1:30pm 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 Chatsworth House DS0000026651.V331876.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. Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chatsworth House Address 9 Belvedere Road Redland Bristol BS6 7JG 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) 0117 9743253 0117 9743258 chatsworthhouse@tiscali.co.uk B & C Care Limited To be Appointed Care Home 15 Category(ies) of Dementia - over 65 years of age (15) registration, with number of places Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th June 2006 Brief Description of the Service: Chatsworth House is a privately 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 65 years and over who have dementia. It is situated in a residential area close to Durdham Downs in Westbury Park and is located close to major bus routes. 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. There is currently an application with The Commission for Social Care Inspection to extend Chatsworth House and increase the number of residents to be accommodated by six. The range of fees is currently £376 and £475 / week and extra charges are made for chiropody, hairdressing etc. Currently this information is provided verbally prior to admission and then confirmed in writing within a new residents contract. Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place midweek between the hours of 1:30am and 8:00 pm. Evidence was gathered from: Examining previous correspondence with the home including: Regulation 37 (Death, illness, other events notifications) and Regulation 26 monthly reports compiled by the responsible individual; inspection reports; relatives comment cards (4), GP / Healthcare Professional surveys (3); talking to/observing residents, talking to the manager, talking to and observing staff, talking to eight visitors, talking to and case tracking three residents; examining records, policies and procedures. What the service does well: People moving to Chatsworth House can be sure that their individual assessed needs can be adequately met. Care plans and individual risk assessments are of a reasonable standard ensuring that residents’ needs are fully identified and on the whole met. Residents and their relatives are confident that their concerns will be listened to and have been made aware of the complaints procedure. The management of the home has gone through a major change with signs that residents and staff are starting to benefit from a highly motivated manager. Continued support is needed from the responsible individual to ensure this transition continues to takes place with minimum disruption to residents and staff and that the home is run in the best interests of residents. Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Information provided to prospective residents and their representatives is still not wholly satisfactory. Residents cannot make a fully informed choice about whether they wish to move to Chatsworth House. Attention to the information about the physical environment is required to ensure that prospective residents and their representatives are clear about the lack of facilities for disabled residents or residents with reduced mobility. The health care needs of residents are on the whole met with evidence of satisfactory multidisciplinary working taking place on a regular basis. However there are gaps in first aid training which be urgently dealt with to ensure residents are not put at risk Opportunities to experience a stimulating and varied life where various informal activities and outings take place have improved slightly since the last inspection so that residents’ individual social needs are beginning to be met. However further improvement is required to ensure that residents individual needs are fully met Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 7 The arrangements for protecting residents from harm have improved since the last inspection. However further improvement is required to ensure that the systems in place are robust and staff have had the necessary training to protect residents from possible risk or harm. There have been both minor improvements and further deterioration in the health and safety, comfort and cleanliness of Chatsworth House since the last key inspection. Urgent attention is required to ensure that residents live in a safe, comfortable, clean environment, which meets the needs of all residents including those who have reduced mobility and those who like to walk without restrictions. The procedures for the recruitment of staff has improved considerably since the last inspection. However , further improvement is required is required to ensure that the procedures are fully robust to protect residents accommodated at Chatsworth House. Staff training has improved considerably since the last inspection. However, further attention is required to ensure that some minor gaps in statutory training is addressed to ensure that all residents’ individual needs are protected from risk of harm . Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chatsworth House DS0000026651.V331876.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 Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. Information provided to prospective residents and their representatives is still not wholly satisfactory. Residents cannot make a fully informed choice about whether they wish to move to Chatsworth House. Attention to the information about the physical environment is required to ensure that prospective residents and their representatives are clear about the lack of facilities for disabled residents or residents with reduced mobility. People moving to Chatsworth House can be sure that their individual assessed needs can be adequately met. EVIDENCE: Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 10 The statement of purpose clearly sets out the objectives and philosophy of the home supported by a residents’ guide that summarises the statement of purpose and provides information about the home. Chatsworth House is currently registered to provide accommodation to residents who are sixty-five years and over who have dementia. This document was observed to be of a good standard at the last key inspection in June 2006. However, it was drawn to the attention of the manager at the time that an accurate account of the physical environment of the home is not fully reflected in the statement of purpose and that disabled access, facilities and equipment are not fully available. A requirement was made at the last inspection to rectify this but the home has not responded. Chatsworth House also currently has limited communal space both internally and externally for residents to walk without restriction or for wheel chair users. The registered manager left Chatsworth House in June 2006 and a new manager started at the same time . The Statement of purpose has not been updated with the change in management and information about the physical environment has not been included The service user’s guide was revised in July 2005. There has been no review of this document since this time. The service users guide is written in plain English and photographs of residents and staff make it more accessible to residents and their relatives. A sample of residents’ files were examined and it was noted that they had up to date contracts and statements of terms and conditions in place, which had been signed by the residents’ representative. A sample of needs assessments were seen which had been completed prior to residents’ admission. They 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 very good standard and there was information to confirm that the family or representative had been involved with the completion of this assessment. Each resident is provided with a statement of terms and conditions prior to moving to the home. This sets out what is included in the fee, the role and responsibility of the provider and the rights and obligations of the resident. Records confirmed that residents’ care packages are reviewed within 4-6 weeks of admission to the home to ensure that a residents’ individual needs can be met Chatsworth House DS0000026651.V331876.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): 7,8,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and individual risk assessments are of a reasonable standard ensuring that residents’ needs are fully identified and on the whole met. The health care needs of residents are on the whole met with evidence of satisfactory multidisciplinary working taking place on a regular basis. However there are gaps in first aid training which be urgently dealt with to ensure residents are not put at risk The systems in place to support residents at the time of their death has improved since the last inspection so that residents and their relatives can be assured that they are treated with care and sensitivity. Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 12 EVIDENCE: A small sample of care plans and risk assessments were seen. They were very clear and well detailed. There was evidence to confirm that the manager in consultation with the resident and their representative reviewed them on a regular basis where possible. During the course of the inspection the inspector overheard a formal review taking place between the manager and a relatives’ son. The resident in question has very complex needs and is highly dependent. The manager managed the review in a sensitive and supportive manner. The relative told me that he was very impressed with the care and support his mother received from the staff team at Chatsworth House. However, some comments received from relative’s responses to the surveys that reviews did not happen enough. This was confirmed when meeting relatives at the social event held on the evening of the inspection. There was evidence in place to confirm that General Practitioners, Psychiatrists, Community Psychiatric Nurses, District Nurses, dentists and chiropodists are contacted at the appropriate time. For example, it was noted from the sample of files seen that residents were supported to attend outpatient appointments, including eye tests and chiropody appointments. There was evidence of equipment in place to prevent pressure sores in residents who were at risk. Evidence also confirmed that the advice of the continence advisor was sought on a regular basis. Evidence confirmed that all staff have attended manual handling training since the last inspection. Comments received from one of the GP who visits the home stated, “I am aware that there has been a change in management and/or ownership to this EMI care home. Prior to this change after the previous manager had left I had significant concerns about this residence. It is too early for me to judge any improvement but I think this should be inspected regularly until it is clearly established as a safe caring environment for highly dependent residents” Responses from District Nurses included” I believe this residential home works very hard to maintain good quality of care to residents in very often difficult circumstances. The staff are always keen to work with District nurses to strive to improve standards of care where needed “. There is a gap in first aid training in this home. The manager is a qualified First aider and only one other member of staff has received updated training. This is not satisfactory Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 13 Evidence confirmed that staff participate in training in working with people with dementia care and mental health needs. There is also written information available to support staff to provide this specialist care. The medication administration system was not inspected during this inspection due to a social event-taking place in the home for Mothers Day. Evidence confirmed that staff involved with administering medication now receive medication training from the local pharmacist. Following the last inspection the majority of staff members have received an up-date in the basic principles of care with a focus on equality and diversity training. It was observed during the inspection how all staff members treat the residents with dignity and respect. The inspector saw staff knocking on residents’ doors and waiting for a response before entering. Staff were observed supporting residents to dress appropriately and preserving residents’ dignity when attending to them in the communal lounge. This information was confirmed in discussion with relatives during the social evening held on the day of the inspection. The management team has clear and robust plans for the care of residents who are dying. There was written evidence to confirm that residents plans are now beginning to contain clear information about residents’ wishes based on discussions held on admission to the home. There was evidence to confirm that the management team provide opportunities for staff to express anxieties and share emotional stress in this area of work. Training in death and dying. Has recently commenced in this home. Chatsworth House DS0000026651.V331876.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. Opportunities to experience a stimulating and varied life where various informal activities and outings take place have improved slightly since the last inspection so that residents’ individual social needs are beginning to be met. However further improvement is required to ensure that residents individual needs are fully met The meals in Chatsworth House are on the whole well managed and provide daily variation, good nutrition and social contact for people. Following the last inspection staff have received further training so that residents’ independence, and right to have choice and control over their lives is maintained as much as possible. Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 15 EVIDENCE: There is evidence in place to confirm that the staff team are aware of the need to plan the routines and activities of the home in a way which meets the choice and wishes of residents. The staffing levels have improved since the last inspection with the result that staff have more time to spend with residents either individually or as a group. There is an activities person working in the home. During the inspection she confirmed that activities are now taking place on a regular basis. Some residents had been involved in activities such as painting, a game of skittles and exercising, ball games and listening to music during the week of the inspection. There was no evidence to confirm that outings are taking place in this home. The last one took place in January 2006. The home currently had no access to a minibus and although staffing has improved it was understood that there is still not enough staff to accompany residents on outings and care for those who are unable or do not wish to go out . This information was confirmed in the staff rota. As discussed at the last inspection a few residents continue to be escorted to the shops or for a short walk, but it was noted that these were the same few residents who were more physically independent and mobile. It is good practice to escort residents into the community following risk assessments, but staffing arrangements and equipment such as wheelchairs should be in place for this service to be equally available to all residents. During the inspection several residents were observed having a sing-along with a member of staff in the communal lounge. All resident observed clearly enjoyed this activity and said so. Following the last inspection the manager approached The Mental Health In reach team who work with staff who provide care to residents with dementia. Relatives’ social evenings continue to be held every three months to which all relatives’ carers and friends are invited. This was confirmed by family members who were very positive about these evenings. As discussed previously a social evening was held on the day of the inspection to commemorate Mothers Day. The inspector participated in this event and had the opportunity to meet several residents who were very positive about the care provided. The inspector observed residents enjoying themselves with family friend and staff , A live musical entertainer was present and residents were observed singing and dancing. Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 16 The home has open visiting arrangements and residents are supported to entertain their visitors in their own room, or the communal dining area when not being used for a meal, or the courtyard if they are able to access this outside space. Relatives confirmed this information. A local Catholic priest visits the home twice a month to take mass. The manager explained that several of the other residents enjoy participating in the service. During the course of the inspection the inspector saw lunch being served in the communal dining room. The meal looked wholesome and nutritious, and it was noted that there was a choice. Residents were observed enjoying each meal. Staff were seen to support residents in a respectful unhurried manner. Information about the daily menu is made available on a board close to the dining room. The inspector also looked into the freezers and fridges and saw evidence of frozen fresh meat and fish as well as a limited amount of ready prepared food . There was evidence of fresh fruit and vegetables in the home. The food/ drinks served at the social evening was noted to be of good quality . The manager explained that they were in the process of recruiting a new chef . The previous chef had left due to limited understanding of English. The manager and activities coordinator are currently helping with meal preparation and cooking. Chatsworth House DS0000026651.V331876.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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are confident that their concerns will be listened to and have been made aware of the complaints procedure. The arrangements for protecting residents from harm have improved since the last inspection. However further improvement is required to ensure that the systems in place are robust and staff have had the necessary training to protect residents from possible risk or harm. EVIDENCE: Residents, and staff told the inspector that they were comfortable talking to the new 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. The Commission for Social Care Inspection has received one complaint following the last inspection . An investigation was conducted in August 2006 as part of a random inspection Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 18 and the conclusion was that the home was not at fault in the handling of the situation. Relatives told the inspector , “I have no complaints here. Staff are very caring. S/he has everything s/he needs. If there was a problem I would speak to the manager”. A couple of relatives confirmed they had been given the complaints procedure when their relative was admitted to the home. No Secrets in Bristol (Local Authority Adult Protection procedure) is in place in the home. Staff that work at Chatsworth House have now been enrolled on adult protection training with Social Services and Health and this programme of training started at the end of February 2006 and is ongoing for all staff to complete. Written evidence confirmed that members of staff were attending this training and during the inspection staff demonstrated what they would do if they suspected abuse had taken place. However, prior to the inspection it was noted that the new manager has not attended this training and was not fully aware of the Local Authority policy and procedure. Recruitment checks were examined as can be seen in the section on staffing. There has been an improvement in the systems in place since the last inspection following enforcement action and staff no longer commence work with out Criminal Records Bureau check and Protection of Vulnerable Adults check being carried out first. Chatsworth House DS0000026651.V331876.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): 19,20,21,22,23,24,25,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There have been both minor improvements and further deterioration in the health and safety, comfort and cleanliness of Chatsworth House since the last key inspection. However, urgent attention is required to ensure that residents live in a safe, comfortable, clean environment, which meets the needs of all residents including those who have reduced mobility and those who like to walk without restrictions. Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 20 EVIDENCE: During the course of the inspection the inspector completed a tour of the whole building. The communal areas were inspected on the ground floor and were observed to be basically clean and smelt fresh. It was observed that all carpets and upholstery are kept clean and disinfected following a requirement made at the last inspection. The home has purchased a heavy duty carpet cleaner. The whole house is beginning to look worn and neglected and in need of urgent decoration. There is a proposed application in place to extend the home by six beds. This application has not yet been submitted following enforcement action taken by The Commission for Social Care Inspection. The registered provider previously informed the inspector that there are plans for other areas in the home to be redecorated once the extension is completed. A dedicated domestic assistant has been appointed to work four days a week, The night staff continue to carry out some of the cleaning tasks when residents are asleep at night. The tour of the premises also included the basement area. This area consists of the office, staff area, laundry facilities, and cellar for storage. It is a very cramped dark area that is not fit for purpose. It was noted that there are plans in place for a major refurbishment of this area to be conducted if the application to extend to the home is agreed. The linen cupboard was viewed and the inspector observed the contents of towels and bed linen. All linen and towels seen were satisfactory. All bedrooms were viewed on this inspection. It was noted that very few met the National Minimum Standards. The inspector saw one empty bedroom, which contained a bed with broken slats on the base. The manager said this bed had been already been repaired once and that he had reported it again to the handy man who visits the home. The mattress was noted to be of a poor quality and was heavily stained. Other mattresses were examined and were noted to be covered with plastic protectors, but of poor quality; some had minor stains and others were satisfactory. Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 21 A number of issues in relation to privacy, comfort, health and safety were noted. For example, curtains coming off rails in a couple of bedrooms and several bedrooms did not have net or voile in place. One window restrictor was broken and may potentially fall on residents or staff members’ hands and cause an injury. Two wardrobe doors were noted to be broken and a set of knobs had fallen off a chest of drawers. It was observed that it would make it difficult for the occupants of these rooms to access the contents of these pieces of furniture. Not all bedrooms had bedside lights in place and in some cases existing lamps had no shades. Some bedrooms were noted to be in need of redecoration and in one bedroom it was observed that the skirting board was coming away from the wall. Only one bedroom has been decorated since the last inspection and that one bedroom did not smell fresh. The majority of bedrooms had call alarms in place, but the cord had been removed. Or the bed was in a position where a resident could not access the call alam. There was no written information to confirm why this had taken place. The inspector was informed that the majority of residents would not use a call alarm but would call out if they needed help. The inspector noted that the two waking night staff base themselves in the downstairs lounge when tasks have been completed so that they may not be able to hear residents calling for attention. For example, if a resident called out from the top floor (3rd) it would be very difficult for staff to hear. Records confirmed that night staff carry out 1-hourly visits to check on residents throughout the night. This had been a requirement of the last key inspection. An immediate requirement was made during this inspection to ensure that all residents had access to a functioning call alarm unless risk assessment demonstrated otherwise. A tour was made of the toilet / bath and shower facilities for residents. They did not meet the national minimum standards. There are three toilets on the ground floor. One has a shower facility installed. Saff rarely use the shower facilities when they are supporting residents. It is a very small confined space, looks worn and is in need of up dating. There is a toilet facility which staff and visitors use, which is also worn and very basic. The third toilet facility is close to the lounge and dining area. There had been a leaking pipe and work had been completed, but the area was in need of redecoration. The ceiling also was in need of attention. This facility is used for wheel chair users, but is a very confined space. It is also very basic and lacks pictures and signs of homeliness. The bathroom / toilet facility room on the second floor has a walk in bath (Lifeguard) installed (it was observed that this bathing equipment is quite dated, but was informed that it is well maintained). This bathroom has recently been updated with new tiles. The bathroom on the third floor is very basic and is in need of up dating . Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 22 There is no evidence of a planned programme of refurbishment / redecoration in place in this home. All minor repairs are reported to the handy man according to the management team. Throughout the inspection it was noted that the access arrangements, adaptations and facilities for disabled service users did not meet the national minimum standards. Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels have improved since the last key inspection. Current staffing levels ensure that residents’ dependency needs are met at all times. The procedures for the recruitment of staff has improved considerably since the last inspection. However, further improvement is required to ensure that the procedures are fully robust to protect residents accommodated at Chatsworth House. Staff training has improved considerably since the last inspection. However, further attention is required to ensure that some minor gaps in statutory training is addressed to ensure that all residents’ individual needs are protected from risk of harm . Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 24 EVIDENCE: During the course of the inspection a discussion took place with the manager and staff regarding the staffing levels. The staff rota was also examined. Evidence confirmed that staffing levels have improved since the last inspection and that the manager and deputy management tasks are they are usually extra to the care staff on duty. Evidence confirmed that staff are no longer expected to work exceptionally long shifts or for many days with out a break. Some staff have however signed up to the European working time directive. The majority of staff now do night duties on a rota basis. Staff confirmed they prefer this arrangement . The manager confirmed during the inspection that the current staffing levels were adequate for the dependency levels of residents in the home. The inspector examined a sample of personnel files of four members of staff. Evidence confirmed that all information and checks had been satisfactorily carried out including ensuring the validity of work permits. There was one query about a work permit and the inspector strongly advised the registered provider to contact The Home Office for advice. He agreed to do that following the inspection. As discussed earlier there is a new manager in post who is currently in the process of registering as manager with The Commission for Socia Care Inspection. During the February key inspection it was noted that there were four members of staff employed on working visas from Bulgaria. It was noted that they all held health professional qualifications from their own country, but were employed as care assistants. Two of those members of staff continue to work in the home. Both members of staff attend English language course and are making good progress. Following appointment the new manager has been actively engaging in organising training for himself and the staff team through Bristol City Council Adult Community care training department. This is a major improvement to the distance learning in place previously. Chatsworth House DS0000026651.V331876.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): 31,32,33,34,35,336,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home has gone through a major change with signs that residents and staff are starting to benefit from a highly motivated manager. Continued support is needed from the responsible individual to ensure this transition continues to take place with minimum disruption to residents and staff and that the home is run in the best interests of residents. Support to care staff has improved since the last inspection. A formal support system is in place, which ensures that the majority of residents benefit from staff that are appropriately supervised. There are good systems in place to ensure that residents’ financial interests and valuables are safeguarded by the homes record keeping, policies and procedures. Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 26 Health and safety checks are satisfactory. The systems ensure that the health, safety and welfare of residents and staff is promoted and protected at all times. EVIDENCE: The new manager has several years of management experience in an alternative setting and has worked with people with dementia. The deputy manager has completed NVQ 4 in Health and Social Care but is shortly to go on leave of absence. Alternative plans for a deputy are now in place. Evidence confirmed that these two members of the management team are beginning to work well together. Positive comments were received from members of staff about the management team, “I would talk to the manager if concerned about anything to do with residents staff. I am happy, comfortable at this place. I enjoy work and supervision. The manager and deputy manager are a good team”. Three members of staff said, “the management team provide good support. The atmosphere is very good here we all get along together”. The Company that owns Chatsworth House changed before the l February 2006 Key Inspection. It now consists of a sole director who is also the registered responsible individual who conducts monthly visits to the home as required to by the legislation. He also designates responsibility to his personal assistant / financial adviser . There have been considerable improvements to the monthly visits and there is evidence to confirm that residents and staff are fully consulted during their visits to the home . The Commission for Social Care inspection receive this report on a regular basis by request. The responsible individual has training courses to up-date his knowledge and skills. This training included dementia care training. An external financial auditor visits the home on a regular basis. There are satisfactory arrangements in place to hold secure any finances held for residents. Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 27 The majority of records, policies and procedures examined were noted to be up to date. Evidence confirmed that the management team were in the process of reviewing the policies and procedures in the home. All staff consulted felt well supported and confirmed that they had regular team meetings and supervision. Written evidence confirmed this information. However the failure to meet a requirement from the last inspetion regarding the statement of purpose is of some concern. The fire log was examined and it was noted that all fire safety checks and training were up to date. There is a fire risk assessment in place, which is regularly reviewed. All other health and safety checks examined were noted to be up to date and accurate including Regulation 37 notifications about the well being of residents. It was noted that these notifications are sent to The Commission for Social Care Inspection at appropriate times. Chatsworth House DS0000026651.V331876.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 2 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 3 3 1 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Chatsworth House DS0000026651.V331876.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 OP1 Regulation 6 Requirement The statement of purpose must be updated to include accurate information about the physical environment to ensure that prospective residents and their representatives are clear about the lack of facilities for disabled residents. This requirement is out standing from the last key inspection conducted on the 26th June 2006 All staff must receive first aid training. There must be one designated first Aider on duty at every shift Arrangements must be made for resident to keep in touch with the local community through outings and excursions Timescale for action 15/05/07 2. OP8 18(1)(c) 31/05/07 3. OP13 16 31/03/07 4. OP18 13(6) 5. OP19 23 All staff including the manager 30/07/07 must attend safeguarding adults training which complies with Local Authority No Secrets in Bristol A planned programme of 31/05/07 redecoration must be sent to The DS0000026651.V331876.R01.S.doc Version 5.2 Page 30 Chatsworth House 6 7 OP22 OP29 23 19 Commission for Social Care Inspection All call alarms must be fully functioning and accessible to residents The registered responsible individual must contact the Home Office for advice in respect of one member of staff 14/03/07 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chatsworth House DS0000026651.V331876.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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