Inspection on 17/12/09 for Chatsworth House

This inspection was carried out on 17th December 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chatsworth House 28/01/09

Chatsworth House 25/01/08

Chatsworth House 14/03/07

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 13/03/2010.

Key inspection report Care homes for older people Name: Address: Chatsworth House 9 Belvedere Road Redland Bristol BS6 7JG     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Odette Coveney     Date: 1 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 39 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 39 Information about the care home Name of care home: Address: Chatsworth House 9 Belvedere Road Redland Bristol BS6 7JG 01179743253 01179743258 chatsworthhouse@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): B & C Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 15. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Dementia aged 65 years and over on admission- Code DE(E)- maximum 15 places Date of last inspection Brief description of the care home Chatsworth House is a privately owned care home that was 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. Six bedrooms have en suite facilities. The home is situated Care Homes for Older People Page 4 of 39 Over 65 15 0 2 8 0 1 2 0 0 9 Brief description of the care home in its own grounds with a courtyard to the rear. Visitors are welcome at any time and refreshments are readily available. In house activities and entertainments are also provided. The range of fees is currently between 400 and 525 pounds per week and extra charges are made for services, such as chiropody, continence products and hairdressing. Currently this information is provided verbally prior to admission and then confirmed in writing within a new residents contract. Care Homes for Older People Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection took place over eight hours and was completed in one day by two representatives of the Care Quality Commission. The manager was present during the inspection and fully participated in the process. Evidence was gained from a whole range of different sources, including: Information provided within the Annual Quality Assurance of the service. Directly speaking with people who live and work at the home. A review of individuals care records. A tour of the home, an examination of some of the homes records and observation of staff practices and interaction with the people who live at the home. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home. Progress was also Care Homes for Older People Page 6 of 39 assessed against the six requirements and eight recommendations made during our last key visit to the service which was undertaken in January 2009. The manager has kept the Commission informed of events that have occurred at the home and of the progress made with the requirements and recommendations that had been set by us at our last key visit to the home in January 2009. Care Homes for Older People Page 7 of 39 What the care home does well: What has improved since the last inspection? What they could do better: Admission assessment documentation is in place and the information recorded within these is good, however, these assessments should be numbered, this will ensure that the information is kept in the correct order and will avoid any possible confusion. The home must review the contracts that are in place for the people who live in the home. This in order to ensure that they contain clear, factual and up to date information about the term, conditions and the financial arrangements that are in place for them whilst they are living at Chatsworth House. Care Homes for Older People Page 8 of 39 Copies of the Power of Attorney and Guardianship arrangements should be obtained by the home. This will provide information of what this means for the individuals concerned. These documents should be obtained and retained, this will show what the responsibilities and the limitations of this role are. End of life care planning should be reviewed in order to ensure that advanced decisions which are made are clearly recorded, evidencing who has been involved with the decisions made. Also taking into consideration individuals rights, choices and relevant legislation, such as the Mental Capacity Act. Medication which has been prescribed to be given as and when required should have clear protocols in place in order to guide and direct staff practice. This will further ensure that people are being given this medication as per their doctors instructions. Medication records, including controlled medication, must contain correct information about medication which is administered. This is in order to ensure that medication is given as prescribed and as per the GPs instructions. Those areas identified within the environmental section of this report must be addressed. This in order to ensure that those living at Chatsworth House are provided with a safe,clean and suitable environment. There are people who have bed sides, these are in place to prevent people from falling out of bed. No risk assessments were in place for this equipments use. It is required that risk assessments are completed and these must record any potential areas of concern and what action is being taken to avoid any preventable injuries. Information about the use of this equipment should also be incorporated within individuals care plans The home should complete a full audit of training. This in order to identify which training has been undertaken by staff, this will further provide an opportunity to ensure that training completed (ie: first aid, basic food hygiene and manual handling) is still up to date and that staff are working in line with current good practice guidelines. An audit of training will determine areas of deficit within the skills of staff. This audit is to include core training such as protection of vulnerable adults and fire safety as well as more specialist areas such as dementia care and medication competency. It is then the responsibility of the Registered Person to ensure that staff are provided with the training they require in order that they are fully equip with the knowledge and skills needed to order to perform their duties and support the people who live at Chatsworth House. Letters of engagement/staff contracts must be reviewed in order to ensure they contain accurate information about individuals job titles and responsibilities. New letters of engagement/contracts should be issued if the information held is not correct. The Registered Manager must prepare an improvement plan to show how the required changes will be made at the home. This is to address the requirements and recommendations made as a result of this visit. This is so that the quality of care is improved. This improvement plan must be forwarded to the Commission in order that Care Homes for Older People Page 9 of 39 we may monitor and review progress. The Registered Manager must conduct an overall review of the quality of care so a service development plan can be devised. This is so that the service is run in the best interests of the people who live there It is recommended that the home review its system for the recording of fire equipment and safety checks in order that it is fully reflective of the practices within the home, furthermore, the Registered Person must ensure that all staff have received sufficient qualities of fire safety instruction/training. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 39 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is assuring peoples care needs are assessed prior to admission and they have the opportunity to visit, before deciding to move in the home. Information is provided to allow prospective new residents the opportunity to make an informed choice about moving into the home. Contracts are in place, however, these do not fully reflect the terms and conditions of the placement. Evidence: At the time of our visit the home were in the process of updating their Statement of Purpose, the updated version was forwarded to us promptly following our visit. This updated Statement of Purpose is specific to the individual home and the resident group they care for. It clearly sets out the objectives and philosophy of the service Care Homes for Older People Page 12 of 39 Evidence: supported by a service users guide. The Statement of Purpose details what the prospective residents can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff, how to make a complaint and also the most recent Care Quality Commission inspection findings. At our last key visit to the service which was completed in January 2009 a recommendation was made that the homes complaints procedure needs to be added to their Statement of Purpose. The home had included this within the documentation as recommended, providing detailed information for people in this area. The recommendation had been met. The records of four people who live at the home were examined in detail. Each person had a completed assessment of need and a pre-admission assessment completed by the manager. At the last visit to the service we recommended that pre-admission assessment documentation should be retained along with all other documentation completed in respect of people living in the home. We found this information to be in place for the care files that we reviewed. The assessments completed were very detailed and was made up of a considerable number of pages, it is recommended that this documentation should be numbered, this will ensure that the information is kept in the correct order and may avoid any possible confusion. We saw that within the assessments full information had been obtained about peoples health, welfare, social, medical and emotional support needs. These assessments provides additional information from which the home can base their assessment, which in turn will direct the care plan. The homes Statement of Purpose also confirms that people are able to have trial period of up to four weeks at the home in order for them to assess the quality, facilities and suitability of the home and to decide whether the home is able to meet their needs. One person we spoke with told us they were new at the home, that they were happy and had settled in well. For most of the files we reviewed (with the exception of one person) we saw that each person had contracts in place, one is provided to the home from the placing/contracting local authority, this outlines the financial arrangements for the placement. The other contracts in place are those which have been developed by the home. These outline the terms and conditions of the placement between the home and the resident. We found that not all residents had one of these contracts and for some people it was not clear about the financial arrangements for third party contributions, the information about the manager was out of date as were the details Care Homes for Older People Page 13 of 39 Evidence: about the regulatory commission. We also saw that within these contracts the wording in respect of the payment for continence products was misleading. It would appear that the contracts suggest that people have to pay for these products, this is not the case. These are provided free to those who have been assessed as needing these products and an additional costs would be incurred if people wished to purchase additional products. The manager informed us that the contracts developed b the home are in need of review would action the suggestions which have been made by us. Intermediate care is not provided at this home. Within the completed Annual Quality Assurance Assessment (AQAA), which had been completed by the home and returned to us prior to our visit, the home had recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are; All care plans to be updated, regular satisfaction surveys to be carried out. Training to improve by working closely with our sister home. To work with our adviser to update and maintain the home, To improve decor and to purchase new items for the home. Care Homes for Older People Page 14 of 39 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person living at the home has a care plan in place, which is kept under review. However, some plans do not provide sufficient information on specific care needs which could place people at some degree of risk. People told us that they are happy at the home. People are not fully protected by the homes systems for the safe administration of medication and improvements are required in this area. Evidence: When we visited the home in January 2009 we reported that care plan documents record information about peoples physical health, preferred night time and morning routines, personal care needs, mobility and dexterity, personal safety issues and mental and cognitive abilities. We acknowledged that the plans covered the full range of care needs. However, the aims of the plan of care often did not take account of the identified need and requirements in respect of this were made. We said that the Registered Manager must ensure that a plan of care is prepared for each person. This Care Homes for Older People Page 15 of 39 Evidence: was so that specific information is available for staff about how the individuals needs are to be met. A further requirement made at our last key visit was that the Registered Manager must ensure that each persons care needs are reviewed on a regular basis. This is so that plans remain up to date and any new needs are identified and planned for. At this visit we reviewed the care, and associated documents for a number of people, some were for people who had lived at the home for sometime, others were for people who had recently moved into the home. Within these we saw that each individual has a care plan but the practice of involving residents in the development and review of the plan is variable. The plan includes basic information necessary to deliver the persons care but is not detailed or person centred. We found inconsistencies within care planning information and important information had not been recorded, for example: one person has a health condition which has clear indicators when an exacerbation of their condition may arise yet signs and systems to be observed had not been recorded. Also all of the people living at the home have a diagnosis of dementia yet care plans did not reflect the level of support that each individual required. Care plans are reviewed and updated as required, this is done on a minimum of a monthly basis, or sooner should peoples needs change. People who live at the home have a dementia and are not actively encouraged to be involved in its review or development, the manager is aware of this and she anticipates that a new proposed care planning format will address this, be more person centred and developed and maintained with input from residents and those significant to them. We look forward to reviewing progress in this area when we next visit the home. There are people who live at the home who are supported with their finances by relatives and the local authority in the form of a power of attorney and guardianship arrangements. It is recommended that copies of these powers and what this means for the individuals concerned should be obtained and retained, this will show what the responsibilities and the limitations of this role are. During our visit we reviewed daily record sheets, these are in place to record the general well-being and day to day support and emotional wellbeing of people living at the home. We saw that entries contained factual information, staff had dated and signed their entries, however, it was noted that for a number of people there were considerable gaps between recorded entries. The home should seek to address and improve in this area. The information within these records provides valuable information to assist with the review and monitoring of care plans and the service that Care Homes for Older People Page 16 of 39 Evidence: is being provided. Three people who live at Chatsworth House had completed a survey prior to our visit. They commented that they felt supported by the staff, that staff listen to them and act upon their requests for assistance. People we spoke with told us that they were happy at the home, that they had made friends. Due to the nature of the service provided at the home there are a number of people who have short term memory problems and some people we spoke with were unaware that they were living in a care home. People looked well kept and looked after. Prior to our visit we received two surveys which had been completed by social/health care professionals who visit and have supported people in the home. Within these they informed us: Staff are friendly, helpful and work hard in a challenging environment. During this visit we looked at medication procedures. We observed medications being given out safely. Photographs of each person are kept with their medication administration sheet (MAR chart). There are safe procedures for the ordering of medications. We were concerned to find that when we checked medication held at the home against records of medication which had actually (or not) been given a number of inaccuracies were found. We were further concerned to find that when we checked a controlled medication that was being held at the home this also did not tally with records held. At our request the home contacted their dispensing pharmacist who supplies medication to the home. Whilst we were still at the home they completed a full audit of the stock held controlled medication and took away tablets that were no longer required. We found that there are some people at the home who have been prescribed as and when required or prn medication, these are usually prescribed to be given for people when they become anxious or distressed. The home did not have any protocols or guidance in place about when it is appropriate to give these medications. It is recommended that protocols are developed in order to ensure a consistent, safe approach in supporting people with this aspect of their life. When we were checking medication held at the home we found that tablets within a blister pack had been sellotaped back into the packaging by staff, this is not acceptable practice and must cease immediately. We saw in healthcare records maintained by the home that people were accessing primary services as needed, such as the dentist and optician. We saw that people are also accessing specialist services as required. We saw in records that people had been seen by the district nurse, psychiatrist and are supported to attend appointments as required. Care Homes for Older People Page 17 of 39 Evidence: We discussed with the manager the sensitive area of supporting people at the end of their life. The process the home has in place was explained including how this issue is raised with people. The manager was fully aware of the rights of individuals and told us about how people have been supported, evidencing a caring and supportive approach. We saw that peoples wishes in respect of their end of life had been recorded. We also saw that some people had made advanced decisions about their end of life wishes. It is recommended that end of life care planning is reviewed in order to ensure that advanced decisions which are made are clearly recorded. This should include who has been involved with the decisions made, taking into consideration individuals rights and choices and relevant legislation, such as the Mental Capacity Act. Within the completed Annual Quality Assurance Assessment (AQAA),The plans for improving care for the next twelve months were recorded. For this outcome area this included: Our care plans need to be updated, we need to fund extra staff when able to ensure we can provide stimulating activities and to enable staff to take residents out for short walks or to enjoy time in the garden. Residents who choose to remain at Chatsworth at the end of life would benefit from profiling beds which we have ordered, staff to be trained in terminal care. Care Homes for Older People Page 18 of 39 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of activities are in house and provided on a daily basis. Visitors are made to feel welcome. Meals are home cooked and well presented. Evidence: Evidence of discussion with residents, staff and entries in the visitors book showed that the home actively supports the residents to maintain contact with families, friends and advocates. One person told us that her family visits very regularly and that staff would contact her family anytime she wanted them to. One relative spoken with on the day stated that there are no restrictions to time of visiting and that they visit their relative almost everyday. They are satisfied with the Home and the services provided; Staff are very welcoming, I cannot fault them. The home provides meaningful activities for the people living in the home. Prior to our visit we received three surveys which had been completed by relatives/carers of people who live at the home. Within these they informed us; Staff Care Homes for Older People Page 19 of 39 Evidence: are friendly, efficient, I cannot say I have found any faults, The home provides a safe, clean environment, I find the interaction with the carers and residents very good, they always seem very alert to the needs of people, although it may not appear obvious. Regulation 26 visits are monthly unannounced visits that are undertaken by a representative of the Registered Provider, these visits are recorded. We saw that the person completing this visit had spoken with those who live at the home, asked them what it was like and if they were satisfied with the service and care that they received, no concerns were recorded. We saw that during this visit that recent events held at the home were reviewed, these included; cake making, vintage music afternoon, live music (entertainers visiting the home) and a Pat dog service, where therapy dogs are brought into the home for people to stroke and pet, these sessions appear to be very successful and popular with the residents. We also viewed the homes activities calender for December 2009 and saw a daily timetable of events for those who wish to participate, activities included; current affairs, arts and crafts, board games, movie time and cookery. A religious service is provided at the home on a monthly basis for those who wish to participate, people are supported to attend church services locally. Within the completed Annual Quality Assurance Assessment (AQAA), the home had recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are; With more funding we could arrange extra activities for residents, short walks on the Downs and more one to one activity. It would be good if more relatives attended social evenings but a lot of our residents do not have relatives or friends, we are working to give each resident a key worker that they can build a relationship with. The homes menu was limited when the manager first came into post and she recognised that choices needed to be improved and has worked diligently through consultation and discussion to improve in this area. The future plans of the home are to: Discuss more available activities with the residents and assist them to choose a safe activity within their capability. Meals are well balanced and nutritional and cater for varying cultural and dietary needs of residents. For those individuals who need support during mealtimes, including those who have difficulty swallowing or chewing, staff give assistance. They are discrete and sensitive to the feelings of both the person they are helping and also to others present. At the day of our visit the lunch being serviced was pork casserole served with carrots, potatoes and sprouts, alternatives were available. People were Care Homes for Older People Page 20 of 39 Evidence: seen enjoying their meal. Mealtimes at the home are flexible and relaxed, people can eat in their room if they wish. Staff were observed to be patient and helpful, and allowed individuals the time they needed to finish their meal comfortably. We saw that people who live at the home are consulted about their life. Residents meetings are held and the discussions and outcomes are recorded. We saw that the last residents meeting took place in early December 2009, it was generally a very positive meeting. Care Homes for Older People Page 21 of 39 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is ensuring that people using the service have their complaints listened to and there are procedures are in place to protect them. Evidence: There is a copy of the South Gloucestershire Council policy on The Protection of Vulnerable Adults from Abuse at the Home to ensure that the staff are aware of the protocol to be followed if incidences of abuse occur. The complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint. It also directs the complainant to the Care Quality Commission and South Gloucestershire Social Services. A copy is made available to residents and relatives should they request it. The Commission have received no complaints since the last site visit to the home. The home has in place a complaints logbook and it was seen that issues have been dealt with effectively and fairly. During our time at the home time was spent with people who live there, people employed at the home and visiting relatives, no issues of concern were raised to us. Those we asked knew who to speak with if they wished to raise any areas of concern. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous Care Homes for Older People Page 22 of 39 Evidence: employment, and satisfactory Criminal Record Bureau disclosures. A review of staff files evidenced that not all staff have received training in protection of vulnerable adults. See the staffing section of this report for further details about this. Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of people who live at the home had been reported to the Commission. Within the completed Annual Quality Assurance Assessment (AQAA), the home had recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are: To provide more training for staff with Meadowcare (a sister home), to start regular supervision and appraisals. The manager is working with the deputy manager to enable them to do more staff supervision. The home also plan to Continue to work with social workers and Independent Mental Capacity Assessors (IMCAs) to ensure we know how to best assist our residents and protect their rights. To review the complaints file and work towards having more compliments and less complaints. To support staff who use the whistle blowing procedure when they are concerned. Care Homes for Older People Page 23 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been some improvements to the environment, making Chatsworth House a more comfortable place to live, however, further improvements are required in order to ensure that the facilities provided are in line with the required expectations. Evidence: Chatsworth House is located in Clifton and is close to Bristol City Centre and The Downs an area of green fields. There are some local shops within walking distance. The ground floor is in better decorative order than the first floor. Since our last visit the entrance hall, stairs, lounge and dining room had all been re decorated, improving these areas significantly. Some bedrooms, stairs and hallways are also in need of redecoration. The manager confirmed, that the Registered Provider is planning to address these areas and is also intending to replace the hall carpet and redecorate. Furniture in the communal areas is of good quality and arm chairs are clean and comfortable. We were informed by the manager that the lounge chairs are being replaced in order that they would be more comfortable and suitable for those with mobility difficulties. At out last visit to the service a recommendation was made by us that the two odorous rooms noted by us should be thoroughly cleaned and provided with any new Care Homes for Older People Page 24 of 39 Evidence: furnishings, furniture and floor covering as necessary. We visited these rooms and saw that new carpets had been fitted, new furniture was in place and these areas were odour free. During our last visit to the service a requirement was made that the Registered Manager must ensure that satisfactory standards of hygiene are maintained. We reported that this was to safeguard against contamination, and that clean linen must not be stored on the floor. We saw no areas of concern at this visit, laundry was dealt with as expected and no infection control concerns were seen by us during our visit. The laundry at the home has a commercial washing machine and tumble dryer. We found that all of the toilet and bathroom areas had paper towels for people to dry their hands. There was also soap and antibacterial hand wash available. Staff are provided with protective clothing such as gloves and aprons. On the whole the house was clean and whilst we were at the home we saw a domestic member of staff busy with their duties. We did note that some area; ie; the ground floor entrance hall lights were dusty and attention must be given to high dusting to ensure the home is clean in all areas. We did find that the bathroom areas are dated and functional. We were concerned to find that in one shower area a dirty old sponge was in place, we were told that it had been used to clean the area. This is to be discarded. We found that in this same area there was no lock on the bathroom door, one must be provided in order that people are able to use this facility in private. The toilet area adjacent to the front door was in a very poor state of repair with peeling paint and black mould on the walls do not make for a pleasant environment. The toilet in this room was broken and would not flush, this was repaired whilst we were on site. In an upstairs bathroom we noted that the toilet seat was worn and discolored, this must be replaced. When we were being given a tour around the home we noted a broken electrical plug socket near the kitchen, we brought this to the attention of the manager who told us that this must of just happened as it was not like this the day before. Whilst we were at the home the manager confirmed that an electrician would be visiting the next working day to fix this, that the area had been made safe and a sign displayed in order that this socket is not used until repaired. We briefly looked into the kitchen and saw that the insecutter was dirty, this must be cleaned to reduce the likelihood of cross contamination. The office is located in the basement of the home, near to the laundry and storage areas. We saw an area of the basement which was full of old equipment, mattresses and furniture. This area should be cleared of unwanted rubbish, aids/equipment Care Homes for Older People Page 25 of 39 Evidence: should be returned in order that other people in need may benefit from them. There are adaptations in place throughout the Home and specialist equipment including hoists, bathing aids, mobility aids, sensory aids and handrails. All equipment is serviced and checked for safety as required in order that it is fit for use. We did note that there are people who have bed sides, these are in place to prevent people from falling out of bed. No risk assessments were in place for the use of this equipment. It is required that risk assessments are completed and record any potential areas of concern. Information about the use of this equipment should also be incorporated within individuals care plans. Within the completed Annual Quality Assurance Assessment (AQAA), the home had recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are: We have now employed a weekend domestic assistant so that the home is cleaned 7 days a week, The manager is working on a schedule for all domestic duties, At team meeting staff were encouraged at all times to be proactive in cleaning when they see something that obviously needs to be done. The dining area is now used more in the afternoons and when residents are restless they are encouraged to use this area to talk or play games. We have made some minor repairs and also purchased all new bedding for all of our residents, we are in the process off decorating the lounge and dining room and hallway ready for Christmas. We were informed that there are some plans to redevelop the home. The Commission are to be provided with details of the refurbishment plan for the home, with timescales for when the work will be started and completed. This should include how the impact on the residents will be assessed and monitored. Care Homes for Older People Page 26 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living at Chatsworth House are supported by staff who are caring and who have an understanding of the needs and wishes of people living at the home in order to support the people in their care. However, an audit of staff training is needed in order to ensure that staff have been fully trained and supported in order to fulfill their duties as is required of them. Evidence: At the time of our visit the manager was on duty as were three care staff, catering and ancillary staff. Staffing levels at the time of our visit appeared to be appropriate and sufficient. It is important that appropriate staffing levels are in place. This is so that staff have the time to do their job properly and peoples care needs can be met in a timely manner. At this visit the manager confirmed to us that staffing numbers are also based and allocated depending on the needs and assistance required by those living at the home and that should increased staffing be required at times that this would be provided. Duty rotas seen by us and staff we spoke with confirmed to us that staffing levels were appropriate at this time. During our last visit to the service, following a review of the staff recruitment files a recommendation was made that all references supplied in respects of new staff should be verified to ensure authenticity. At this visit we again reviewed files and found that for new staff all of the required documentation was in place in respect of robust Care Homes for Older People Page 27 of 39 Evidence: recruitment and selection practices. It was found that all of the checks and records required under Schedule 2 of the Regulations had been complied with. This included two references, a Criminal Records Bureau check and clearance from the register of people deemed unsuitable to work with vulnerable adults before the staff started working at the home. Our previous recommendation about historical staff references had not been met. The home must obtain retrospective references for those staff members for whom current information held is not robust enough. This is to ensure that staff are suitable for the work they have been employed to do. When we reviewed staff files we found that for one person they had, over a period of time, had a number of varying roles at the home, they had a letter of engagement for one position, a contract for another and a job description for something else. For another member of staff they had a contract in place for their role as a domestic assistant, but not one for their current role of a care assistant. Letters of engagement/staff contracts must be reviewed in order to ensure they contain accurate information about individuals job tittles and responsibilities. New letters of engagement/contracts should be issued if the information held is not correct. During this visit we reviewed training that had been undertaken at the home. Records were incomplete and unclear and we were unable to determine what training has been undertaken since our last visit to the home. We could see that historically staff have completed some training in sensory deprivation, infection control and person centred care. The home must complete an full audit of training, in order to identify which training has been undertaken by staff. This will provide an opportunity to ensure that training which has been completed (ie: first aid, basic food hygiene and manual handling) remains up to date and that staff are working in line with current good practice guidelines. Also this will determine areas of deficit within the skills of staff. This audit of training is to include all core training such as protection of vulnerable adults and fire safety as well as more specialist areas of training required for a service of this nature such as dementia care and medication competency. It is then the responsibility of the Registered Person to ensure that staff are provided with the training they require in order that they are fully equipped with the knowledge and skills needed to order to perform their duties and support the people who live at Chatsworth House. We saw that staff meetings occur regularly at the home, the most recent meeting took place in November 2009. These meetings provide an opportunity for staff to make suggestions about the running of the home and furthermore provides an opportunity to discuss the service being provided in order that there is effective communication and continuity of service. The minutes of the most recent meeting were seen, we saw Care Homes for Older People Page 28 of 39 Evidence: that areas of discussion included staff role and responsibilities, duties, medication and management expectations. Directions given to staff from the manager were clear, supportive and demonstrated a team being approach. Prior to our visit we received six surveys which had been completed by staff who work and support people who live in the home. Within these they informed us; We provide the best quality of service for our residents, which is our main concern. We have regular staff meetings if in order to look at ways we can improve the service for our residents. Based on my observations, we provide a good standard, like health and safety to our residents and we have accessible facilities. Another person said; Chatsworth aims to meet individual needs and ensure that service users are given plenty of choice and activities to take part in, key workers are allocated to work with people on a one to one basis when possible. Another person said; The home is in need of some TLC, for example painting and decorating. Within the completed Annual Quality Assurance Assessment (AQAA), the home had recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are; To increase staffing to 3 in the afternoon as soon as possible, to encourage staff to use their leave spread out over the year so we do not have staff shortages. For all staff annual leave to be booked one month in advance. All staff to have training record and regular supervision and appraisal. To continue to hold regular staff meetings. Care Homes for Older People Page 29 of 39 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has no registered manager but current leadership and management arrangements on the day of the visit were satisfactory. Evidence: At our last key visit to the service a recommendation was made that the Commission must be notified of the management arrangements for Chatsworth House if the absence of the registered manager is to be for any further length of time. The home have kept us informed and since our last visit to the home the previous manager has left. A new manager is in position, Jacqueline Shipley. Ms Shipley had been in post for eight weeks at the time of our visit. Ms Shipley has many years of experience within the care sector. She is qualified to NVQ level 4. We discussed with Ms Shipley the registration process in order that we can determine her fitness to manage the care home. The manager assured us that she was in the process of completing her application for the Registered Managers post and that this would be submitted to us promptly in order that the process can commence. Care Homes for Older People Page 30 of 39 Evidence: On the day of our visit there was a good, friendly interactive atmosphere at the home. Residents looked well care for and were talking to staff in an informal way. Staff and residents spoken with were complimentary about the managers ability to manage the home. Whilst the home has no registered manager the current manager, Ms Shipley showed professionalism throughout the inspection and demonstrated a commitment in improving the service in order to benefit those living and working at Chatsworth House. Staff stated that the manager was approachable and would listen to their comments and acted accordingly. Within a survey completed by a member of staff prior to our visiting the home they said; There has been a marked improvement since our new manager came to Chatsworth House. In general everythings getting smoother like the relationships between staff, manager, relatives of residents and especially our residents. During our last visit to the service in January 2009 we were not satisfied that the home were monitoring the service being delivered, it was required by us that the Registered Manager must prepare an improvement plan to show how the required changes will be made. This is so that the quality of care is improved. This is still an outstanding area and the requirement remains, we have also requested that copies of the regulation 26 monthly visits undertaken on behalf of the Registered Provider are forwarded to us in order that we can monitor progress in this area. Furthermore the Registered Manager must conduct an overall review of the quality of care so a service development plan can be devised. This is so that the service is run in the best interests of the people who live there. The home has good systems in place to manage any monies they hold on behalf of the residents. During this visit two of the accounts were checked against the records held and they tallied, receipts are kept for items purchased. At our last visit to the service we were concerned over the safe moving of people who live at the home, a requirement was made by us that the Registered Manager must complete robust manual handling risk assessment where staff are involved in moving and handling tasks. We also recorded that staff must be provided with instructions on what actions they are to take so that safe moving and handling techniques are followed. Written instructions must always be followed. A full review of this area was undertaken during this visit, the requirement had been met, required documentation was in place, no concerns over manual handling practices were noted or seen by us. The home has in place a number of risk assessments relating to the running and Care Homes for Older People Page 31 of 39 Evidence: management of a care home. We saw that these assessments were well written and contained clear information in order to direct and inform staff practice. We noted that these assessments had recently been reviewed in August 2009, assessments seen by us included use of electrical appliances, slips/trips/fall, danger of window openings. We reviewed accidents and incidents which had occurred at the home, those seen by us were situations that could be expected to occur. Accident reports had been well written and showed what had happened, what injuries had been sustained and what the home had done to support the person involved and measures taken in order to try to prevent recurrence. During our last visit to the home a recommendation was made by us that the home should obtain the advice of the Fire Officer to ensure that they were complying with the Regulatory Reform (Fire Safety) Order. We saw that following our visit the manager contracted the fire authority and requested that they visit. A fire officer visited the home in March 2009. Two recommendations were made by them. We saw that the home had acted upon the advice of the fire officer and the recommendations made had been met. When reviewing the homes fire logbook we saw that the home were not recording the the daily, weekly and monthly checks as needed. The manager and a staff member told us that the checks take place and named who is responsible for this task. We also found that fire drills and training were not being recorded. We saw that the home have booked a fire training event to take place on 14th January 2010, however, there is no evidence to demonstrate that staff have received recent training in this area, and in the qualities that are required. It is recommended that the home review its system for the recording of fire equipment and safety checks in order that it is fully reflective of the practices within the home, furthermore, the Registered Person must ensure that all staff have received sufficient qualities of fire safety instruction/training, this must be recorded. Prior to our visit we received a completed Annual Quality Assurance Assessment (AQAA). We found that the AQAA contained clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. The Manager had been honest about where shortfalls within the service are, the AQAA shows clearly what they need to do and how they are going to do this. The data section of the AQAA was accurately and fully completed. Within the completed Annual Quality Assurance Assessment (AQAA), the home had Care Homes for Older People Page 32 of 39 Evidence: recorded that their plans for improvement for the forthcoming twelve months, within this outcome area are; To review all care plans and risk assessments and update all paperwork. To ensure more training available and start supervision and appraisal. To encourage staff to undertake NVQ. To maintain and improve all of the standards at Chatsworth. To take feedback from surveys and improve areas that we do not do well in. Care Homes for Older People Page 33 of 39 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The Registered Manager must ensure that plans of care are sufficently detailed. So that specific information is available for staff about how the individuals needs are to be met. 17/04/2009 2 33 24A The Registered Manager must prepare an improvement plan to show how the required changes will be made. This is so that the quality of care is improved. 28/04/2009 3 33 24 The Registered Manager must conduct an overall review of the quality of care so a service development plan can be devised This is so that the service is run in the best interests of the people who live there. 28/03/2009 Care Homes for Older People Page 34 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 17 Medication records, including 15/01/2010 controlled medication, must contain correct information about medication which is administered. This is in order to ensure that medication is given as prescribed and as per the GPs instructions. 2 19 23 The Registered Person must 29/03/2010 ensure that the home is kept in a good state of repair. Attention and action must be given to those areas addressed within the environmental section of this report. This is to ensure that those living at Chatsworth House are living in a place which is safe, clean and suitable. Care Homes for Older People Page 35 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 22 13 The Registered Person must ensure that any activities in which service users participate is free from preventable risks. Risk assessments should be completed for the use of bedsides to ensure that all factors relating to this equipments use have been fully considered. 08/02/2010 4 30 18 The Registered Person must 08/06/2010 ensure that at all times there are suitably qualified, competent and experienced persons working at the home. Also that staff receive the training appropriate to the work they are to perform. Training to be provided in any areas of shortfall identified, such as fire, first aid, manual handling and dementia awareness. 5 38 23 The Registered Person must 22/02/2010 make arrangements for staff to receive training in fire prevention. This training must also be in sufficient quantities. This will ensure that staff have the knowledge in order Care Homes for Older People Page 36 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action to keep people safe and be able to respond appropriately in the event of a fire emergency. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 The home must review the contracts that are in place for people who live in the home. This is in order to ensure that they contain clear, factual and up to date information about the term, conditions and the financial arrangements that are in place. Admission assessment documentation should be numbered, this will ensure that the information is kept in the correct order and may avoid any possible confusion. Daily record sheets must be completely and consistently completed in order that these can support care plans and provide a full picture of the lives of people who live at the home. Copies of the Power of Attorney and Guardianship arrangements should be obtained, this will provide information of what this means for the individuals concerned. These documents should be obtained and retained, this will show what the responsibilities and limitations of this role are. Medication which has been prescribed to be given as and when required should have clear protocols in place in order to provide a consistent approach and this in turn will guide and direct staff practice. End of life care planning should be reviewed. In order to ensure that advanced decisions made are clearly recorded, evidencing who has been involved with the decisions. Taking into consideration individuals rights, choices and relevant legislation, such as the Mental Capacity Act. The home must obtain retrospective refferences for those 2 3 3 7 4 7 5 9 6 11 7 29 Care Homes for Older People Page 37 of 39 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations staff members for whom current information held is not robust enough, this is to ensure that staff are suitable for the work they have been employed to do. 8 29 Letters of engagement/staff contracts must be reviewed in order to ensure they contain accurate information about individuals job tittles and responsibilities. New letters of engagement/contracts should be issued if the information held is not correct. A full audit of staff training should be undertaken, this is to include all aspects of staff skills, such as core training and more specialist training. An action plan, including timescales and priority training must be developed in order to ensure that training is provided in areas of deficit which may be identified. The home to review its practice in the recording of the daily, weekly and monthly fire safety checks in order to ensure that these are being consistently recorded and the outcome of these checks are known. 9 30 10 38 Care Homes for Older People Page 38 of 39 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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