Inspection on 02/05/06 for Chatterley House

This inspection was carried out on 2nd May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 45 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chatterley House 12/02/09

Chatterley House 03/05/07

Chatterley House 21/11/06

Chatterley House 09/02/06

Chatterley House 24/05/05

Chatterley House 14/12/04

Chatterley House 02/08/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Chatterley House Chatterley Road Tunstall Stoke-on-trent Staffordshire ST6 6PX Lead Inspector Irene Wilkes Unannounced Inspection 2 May 2006 9:45 Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 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 Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 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 Adults 18-65. 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. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chatterley House Address Chatterley Road Tunstall Stoke-on-trent Staffordshire ST6 6PX 01782 834354 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Alice Clarke Ms Teresa Sloan Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: Chatterley House is a care home registered for nine people with a learning disability. Seven gentlemen and two ladies currently live at the home, in a detached property set in its own grounds. The proprietors house is also situated within the same grounds. The home is situated just outside Tunstall, which is one of the towns that make up the City of Stoke-on-Trent. It has good access by road, but although there is public transport from other areas to Tunstall itself, bus routes do not extend to the homes location. The home has a mini bus but is currently without a driver. There are few local facilities in very close proximity to the home, although a pub is within walking distance which one or two of the service users use. Tunstall, however, has the range of shops that you would expect of a small town. Chatterley House has five single bedrooms and two double bedrooms. There are spacious communal rooms that are attractively furnished. All areas of the home are generally well maintained. The grounds have attractive gardens and adequate space for car parking. There are links with local colleges and day services to provide service users with opportunity for personal development. Service users enjoy holidays in Wales staying in caravans that are owned by the proprietor. Evidence received from the families of service users confirms that the latest inspection reports are available to them, and service users would be provided with a copy of the Service User Guide prior to admission. The charges for the service range from £319 to £428 per week (05/06 prices). It was found that two service users living at the home are over the age of 65 years, and the home is only registered for nine places for younger adults (1865). The provider has been required to apply for a minor variation to ensure that the home is registered correctly. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a day and a half by one inspector. All nine service users were spoken with at some time during the visits. Three service users agreed to meet with the inspector for a longer chat so that a better understanding could be gained about their lives. Seven service users returned comment cards and answered the questions in them about the service. Four relatives also returned comment cards, as did a Community Nurse who specialises in Learning Disability Services. Two staff, in addition to the manager were interviewed. A tour of the home and gardens, including two service users’ bedrooms was undertaken. Two care plans, which were those of two of the service users who had chatted longer to the inspector, and three staff files, were looked at. Other documents about the running of the home were also seen, including those on staff training, menu plans, medication and maintenance records and the Statement of Purpose and Service User Guide for the home. The home had also submitted a pre inspection questionnaire. Staff practice, including how the staff talked and supported the service users was observed throughout the inspection. What the service does well: The service supports the service users to keep well. Staff make sure that all of the residents have regular health checks with their doctor and attend sight tests, hearing tests and chiropody services as their appointments become due. They also make sure that if someone needs more specialised help that they get it. For example, one service user has the onset of dementia and he has been well supported by the home in the management of this. His relative said: ‘I am very happy with the high standard of care received by X, particularly in respect of the mental and physical problems he has encountered over the last three years. The manager and X have been exceptionally helpful and loving towards him to make sure he has a full life.’ Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 6 The Community Nurse also spoke of the staff being ‘efficient and helpful in their advice and support and in following planned episodes of monitoring of care.’ The service users like living at the home. All of them said that the staff are kind and helpful to them. Two newer service users have settled in well and they smiled a lot when the staff were mentioned. A relative said that she was very pleased with the home overall, that residents are well looked after, and that staff ‘are friendly and informative.’ What has improved since the last inspection? What they could do better: Because of a small staff team with a long-standing vacancy, on some occasions there is only one member of staff in the home for nine residents and this is not considered safe. The manager has received some applications for the post and she has been required to interview without delay. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 7 The manager has been told that she must gain a better understanding of the standards required of her in running the home. These are in place to ensure that the service users health, safety and welfare are protected. It is clear from the views of service users, relatives and visitors that the manager and the staff care very much about the residents, but this lack of understanding could, and has, put them at risk. For example, one service user was left in the home alone, as he did not want to go out for a meal with the other residents and staff. A serious concern letter was issued about this and it must not happen again. Staff had not monitored that a service user who self medicates had not been taking her medication, which could have put her at risk. This is of real concern as the home still has a duty of care to monitor medication via risk assessment procedures even when residents wish to take the lead for themselves. Mandatory training for staff is poor. This has been found at previous inspections and it is disappointing that the home has been slow to act to improve this. They have relied on the fact that in the past they have had more than 50 of staff qualified to NVQ 2 and above but some of the mandatory training obtained via this qualification is now out of date and no effort has been made to renew this. Not enough attention is paid to the content of the course where training has been provided following requirements at previous inspection, such as medication training being completed but this was refresher training when initial training had not yet been received. The home has been given a month before another visit is made to the home when it has been required that dates must have been firmly booked for all mandatory training courses for all staff. This includes abuse training, moving and handling, first aid, fire training, food hygiene. The inspector is also in touch with the home by telephone in the interim weeks to check on progress. Other areas of concern are around record keeping in a number of areas. Records about the information to be provided to service users, about their needs, about individual risks need improvement. Recruitment procedures are not thorough enough. For example staff have been allowed to work in the home without an up to date Criminal Records Bureau check although the home had been specifically told that they could not employ anyone without such checks having been undertaken. This could adversely affect the health and safety of the service users and the home has been required to improve their recruitment procedures immediately. The Commission has had a number of recent meetings with the proprietor and the manager regarding concerns about the lack of a professional relationship between them. It had became apparent that they were not speaking but rather conducting the business of the home by ‘message carrying’ by staff and service users. It has been made clear that this is not acceptable and both parties are required to conduct business between them in a professional manner. The proprietor has also been required to resume regular formal visits to the home on at least a monthly, unannounced basis when discussions with a sample of Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 8 service users, staff, examination of records and a tour of the environment is made. A written report on the outcome of the visit must then be provided to the Commission. The home has been required to complete all of the outstanding work found necessary by the Fire Officer. This consists mainly of fire risk assessments and the home ensuring that they have systems in place to ensure the safety of all of the service users as far as reasonably possible. 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. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home ensures that prospective service users have an assessment of their needs before they are admitted to the home, but other information to help people to make an informed choice, such as the Statement of Purpose and the Service User Guide require improvement. EVIDENCE: The home has a Statement of Purpose in place. However, over considerable time it has been highlighted that the Statement of Purpose does not give a true reflection of the services that are being provided. The document has several omissions, such as a lack of information on room sizes, the age range of service users that the home can accept, and has other statements, such as about the range of services that can be provided that are not actually available in practice. A requirement was made that the Statement of Purpose must be redrafted to contain all of the information as required by the standards and regulations under the Care Standards Act 2000. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 11 Since the last visit the home has redrafted the Service User Guide in a style more suited to the needs of the service users. However, the Guide still has some missing information that is needed by the service users so that they are all clear about what to expect from the service. One important area lacking is about who will pay for staff expenses for accompanying service users to events in the community, such as meals out, leisure facilities, entrance fees etc, and this must be addressed. The service users who were case tracked told the inspector that they had a copy of the Guide and that the manager had talked to them about it and they understood what it was about. Four relative comment cards were returned and each was positive about the information provided to them by the home about the service. Information about the service received by two service users who have lived in the home for 11 months was looked at, including a discussion with both people. Their care files were examined and each of these showed that there had been a full assessment of their needs before they went to live in the home, undertaken via a multi-agency care management assessment process, and that from this the home had developed a service user plan. Whilst the service users couldn’t remember anything about this process, there was clear documentation in their files that their needs and aspirations had been discussed with them, and that an advocate had also been involved to support them through the process. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. Service users are supported to make decisions about their lives, but care planning requires improvement and the conduct of the management of the home in leaving a service user unsupervised put his safety at risk. EVIDENCE: The care plans for the two service users most recently admitted to the home were looked at. Although these have been improved since the last inspection earlier this year they still only contain basic information about how needs will be met. For example, both service users require some support in personal care but the plans do not detail how this support should be provided to assist the service users in the way that they prefer. One service user has limited verbal communication but the plan does not contain any detail about the methods to be used to understand the service user’s needs, such as monitoring facial expression, body language etc. To balance this statement, discussion with a member of staff showed that she had gained some understanding of the Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 13 person’s gestures and the signs presenting when she was pleased/displeased. The service user would benefit, however, from this knowledge being written down to inform all of the staff team. As it stands, the home has only anecdotal evidence to show how they have an understanding of the needs and preferences of the service users, and it is a requirement of this report that improved information is available in the care plan. One of the service users has behaviours that challenge staff on limited occasions. The care plan in place is one that was developed in her previous placement and has not been reviewed since the service user has lived at Chatterley House. There have been a couple of incidents since she has lived at the home, and a review of how she should be helped through these events should be looked at by the home and clear guidance for staff recorded. None of the care plans in place at the home are developed in a style that the service users can understand, but the manager advised that she is researching some training on person centred planning which should overcome this deficit. A requirement has been made that the care plans are improved to ensure more complete information is available. The two new service users living at Chatterley House make decisions about their daily routines and an advocate was involved with their decision making in moving to the home. There was no evidence in their care plans about any discussions about any aspirations or decisions that they need support with currently and in discussion with them the inspector was not able to tell if they had any outstanding issues. The development of person centred planning discussed earlier should assist with gaining a better view of the service users’ wishes about their lives. The other service users resident in the home have lived there for some considerable time. Discussions with two of them showed that they continue to make their own decisions regarding lifestyle, such as a relationships with a lady friend, continuing in sheltered employment, travelling independently etc. The home acts as appointee for all of the service users in relation to their benefits. Some issues regarding failures in this respect are shown under the section on protection. The home must ensure that the records for service user finances must be independently audited/ monitored. There was evidence available in the two files inspected that consideration of the risks that present for each of these service users had improved since the last inspection, when attention to such recording had been made a requirement. The home is reminded that this is an ongoing process and the risks presenting to each service user must be reviewed and new ones considered when life experiences are extended or their needs change. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 14 In discussion with another service user, he confirmed that he made his own decisions about leaving the home independently and what he chose to do, and that staff talked to him about his personal safety, spending his money wisely and such like. It became apparent during the inspection, however, that one service user had been left in the home alone for between 1-2 hours whilst the staff went out for a meal with the other service users. There has been no previous multidisciplinary meeting to discuss the appropriateness of such an action, and there appeared to be no understanding shown by the home regarding the associated risks such as a fire breaking out, the service user hurting himself, unwanted callers at the home and such like. The service user was not available for the inspector to be able to discuss this issue with him as this was the second day visit and he was out. An immediate requirement was made that this practice should be immediately stopped so that no service user is left in the home alone at any time. A letter of serious concern has been sent to the home confirming this required action and requiring a response from the home about how this will be managed. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The home generally supports service users to make choices and to lead a lifestyle of their choice and this has improved since the last inspection. However there is still room for improvement on a consistent basis to meet the needs of all of the service users. EVIDENCE: The last inspection found considerable shortfalls in activities for the two service users who had been the most recent admissions to the home. The initial assessment for each of them had shown that they liked to be engaged in activities outside the home, and this had been achieved on only very few occasions for either of them. It was pleasing to note that this had improved considerably by the time of this inspection, and each now goes out to do personal shopping regularly, which they both like, and out for meals or morning coffee. However, one of the service users has a passion for football Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 16 and going to watch Stoke City, and although this had been raised with the home at the last visit he had still not been to see a match, and the season is now over. The service user said that he wanted to go to the football very much. This lack of meeting needs is of particular concern as the home had received additional funding from the Social Services Department for an additional member of staff to support the two newer residents in activities. The service user’s care plan also showed that he enjoyed gardening but the review of his plan stated that the large garden at Chatterley House seemed to daunt him and he had not pursued this activity further. In discussion, it was clear that there had been no thought by the home to finding other ways that this interest could be met. For example, giving the service user a small patch of garden to tend, using the greenhouse, getting indoor plants etc. Another service user talked about enjoying baking. In chatting he was asked whether he liked to help to cook the evening meal, but he said that all he did was peel potatoes or mash them ready for serving, and he would like to have a go at helping prepare the meal itself. This particular service user has difficulty in finding activities that he likes to do, and the inspector felt that this was an ideal opportunity for the home to support him to develop an interest. To balance the above, several service users living at the home are involved in attendance at day centres, sheltered employment, volunteering work, but this involvement appears to be successful because the service user is able to express their wishes clearly, and/or others such as family or advocates are involved. It was discussed with the manager that the home must pay more attention to supporting all of the service users to take part in activities suited to their individual needs, and this is a requirement of this report. The service users at Chatterley House are all a part of the local community. They each attend, according to their choice, the local shops, library, pubs, church and restaurants. Service users are assisted with transport on a frequent basis by the staff using their own vehicles, but some do use public transport, and some of them have also more recently been encouraged to hire taxis rather than the staff transporting them, to develop their independence. All of the service users living in the home are white British. Until last year there was only one female, but there is now another female resident which assists in the gender balance. The long-standing female service user said that it was good to have another female living in the home. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 17 Evening and weekend activities have improved somewhat since the last inspection. There was evidence in the service user files seen that they have been out for meals and to the circus at these times. However the majority of these outings had been ‘whole group’ ones, which is fine if this is the real choice of all of the service users. However, the inspector had some misgivings as to whether this was in fact so as a staff member indicated that one of the service users had been unhappy at a recent outing. Examination of her care plan showed that she preferred 1:1 interaction or small group activity and it may be that this was the cause. The home is reminded to consider issues about real choices being made by all of the service users, rather than a ‘one size fits all’ approach. Issues regarding staffing to allow more individualised activities are further discussed under the ‘staffing’ heading later in this report. The last inspection recommended that the home provide a notice board with information about local amenities as well as advocacy services, the complaints procedure, most recent inspection report etc. but this has not been provided, and is again recommended. The home is very good at supporting the service users to maintain family links and friendships. Four relative comment cards were returned and each was positive about how they are welcomed into the home and encouraged to be a part of their loved one’s life. The sister of one service user visits on an almost daily basis, and is invited to join in events within the home, and one service user has a girlfriend who visits, and the home support return visits to her for the resident. The two newer residents have also been supported to maintain contact with a lady with whom they used to live. The daily routines of the home promote independence and choice for the service users. Residents were again able to say that they ‘do their own thing’ as one of them put it, and observation during the visit supported this, with people rising at different times. The two residents whose care was looked at in more detail confirmed that they got up and went to bed when they wanted to. The lady without verbal communication confirmed this by nodding her head. Staff were seen to observe the privacy of service users and on every occasion they knocked on the door before entering someone’s bedroom. There was only 1 service user not at home for most of the visit, as others were home as their day centre was closed. They were all very relaxed and either sat in the lounge or wandered to their bedrooms to play music or watch the television. What did present as a concern, however, was that there was only limited talk and interaction between the staff and the service users, with only one or two notable exceptions. The pattern of the day was as has been observed at other inspections, in that staff seem to be much more involved with cleaning and laundry than with engaging service users in any meaningful activities or in conversation. This may well be linked to the small number of staff available Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 18 and that they also undertake cleaning, cooking, the laundry as well as their caring role, but it does need to be addressed. The previous inspection found that the two newer service users had not been asked if they would like a lock on their bedroom door. This had now been addressed, but one of the service users said that he would like something to lock his things in. It is disappointing that the home only thinks to do the exact things that have been stated as requirements in inspection reports, as this could have easily been dealt with much sooner if more thought had been given to the service user’s needs and best meeting them, as a member of staff said that he always liked to ‘hide things away.’ It is a requirement of this report that a lockable box or the like is purchased for him. All of the service users spoken with, including the two people whose care was considered in detail said that they were happy with the food on offer at the home and that they could choose an alternative if they did not feel like something on a particular day. There was a record of the menu plan and the food diary showed the meal on offer, and from the limited examination that an inspection can afford, this appeared to indicate that service users were having a balanced diet. The food diary did not show alternative choices and it is a requirement that these are recorded. Discussion with the service users showed that they did not have much input into the menu plans. For the service user developing an interest in cooking this would be particularly beneficial. Seven service user comment cards were returned and two of these stated ‘yes’ and three ‘sometimes’ when asked if they wished to be more involved in decision making within the home. This is one of the areas in which involvement could readily be implemented. Another service user said in discussion that he would like to go food shopping which the service users are generally not involved in. It is a requirement of this report that service users are actively supported to help plan and become more involved with the preparation of meals, according to their individual needs and interests, and not just as is now the case in the sharing out of household tasks. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. The home ensures that the healthcare needs of the service users are met, but there is poor understanding of safety issues such as in assisting the service users in moving and handling and in the administration of medication. Because of this the service users have been put at risk. EVIDENCE: Information about the support needs of the service users and the way in which they prefer this to be provided was scant in the two files examined. One of the staff explained how she assisted the service user who does not speak and how she had learned to interpret her likes and dislikes by observation, and this needs to be recorded so that care is consistently provided in the appropriate manner. This is a requirement of this report. Additionally a formal moving and handling risk assessment is required for all service users, and if no support at all is needed this should be recorded. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 20 Six of the seven comment cards returned by the service users stated that the staff treated them well. Those spoken with said that they received the support that they require from staff, and that they choose their own clothes, fashion style and overall appearance. The home has designated key workers who support individuals and the service users appreciate this. The views of one service user who commented negatively about the home are known to the Commission and it is considered that the home manage the issues appropriately. Nevertheless, the home is recommended to discuss with the service user and his Social Worker again the reasons why he is not happy. At every previous inspection the home has shown that it pays good attention to the healthcare needs of the service users and this visit followed the same pattern. The care plans inspected showed appropriate recording of all health appointments, health checks, issues and outcomes for each service user. The information supplied by the home prior to the inspection showed that one service user has dementia needs and three service users have continence needs. Discussion with the manager about these mental and physical health issues showed that appropriate health professionals had been involved, including referral to the consultant psychiatrist for the former and the involvement of a continence adviser for the others. A relative’s comment card also contained praise about the home for their approach. ‘I am very happy with the high standard of care received by X, particularly in respect of the health problems x has encountered over the last three years.’ Until recently there were two service users who self medicate. Discussion at the inspection found this to be no longer the case. It was alarming to find that for one service user this was because it was found by accident that the person had not been taking prescribed medication over a considerable period of time. The manager stated that the monitoring that had taken place had been to check that the medication had been stored safely in the lockable space provided, and it became clear that no-one had thought to check whether the medication had actually been taken. It was not clear whether the service user had even been asked about her medication. This lack of monitoring is not acceptable and shows a lack of a duty of care. The service user has since this came to light chosen to no longer self medicate. The other service user has since then also chosen likewise. Further discussion highlighted that the manager was pleased about this as she considered that he took unnecessary painkillers on a routine basis that were prescribed for ‘as and when needed’. This failure to take action in spite of concern is also a failure in the duty of care. The home is required to ensure the safety of all of the service users at all times as far as is reasonably practicable. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 21 Arrangements for the receipt, recording, storage, handling, administration and disposal of medicines were otherwise found to be satisfactory. The home uses the monitored dosage system of medication. The medication cupboard was examined as were MAR (Medication Administration Record) charts. There are no controlled drugs used in the home. The pharmacist undertakes a sox monthly review, and the home have recently purchased a separate lockable ‘fridge for the storage of relevant medicines following the advice of the pharmacist. Whilst all of the staff that administer medication have received some training, discussion evidenced that for the majority of staff this was classed as refresher training by the trainer, but the staff concerned have not had the original full training. A member of staff was questioned about the training and it appeared to be insufficient to meet the needs of the staff for the home. Additionally the training was not formally tested by written means. The manager is required to satisfy herself that this training is sufficiently robust to meet the knowledge base needed by staff, and if it is insufficient then a further suitable training course must be undertaken. The manager was left a copy of the professional advice provided by the Commission regarding medication administration in care homes and the training that is necessary for staff, as the home does not have internet access. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. Staff and the manager have a poor understanding of issues about abusive practice and procedures in the home need to be stronger to protect the service users from abuse, particularly financial. EVIDENCE: Service users are provided with a copy of the Complaints Procedure and this is found in the Service User Guide. The procedure requires the addition of the timescale in which a complaint will be responded to, i.e. within 28 days. The service users said that the procedure had been discussed with them. One of the service users whose care was tracked said what he would do if he was not happy with anything in the home, and it was clear that he understood that he could make his views known and how it would be addressed. All seven of the service users who returned comment cards showed that they knew who to speak to should they have a concern or complaint. The Complaints Log had no recorded complaints for the last year. The manager said that there had been minor grumbles or incidents that had been dealt with but these had not been recorded. The home is required to keep a record of all issues raised or complaints made by service users, including the detail of any action taken and the outcome. This is a requirement of this report. It became clear that although the home had an internal policy for safeguarding service users from any form of abuse this is an ‘off the shelf’ one that does not Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 23 incorporate the local inter-agency procedures for the protection of vulnerable adults. Neither did the home have a copy of the Department of Health guidance ‘No Secrets’ although it had been understood from past conversations that these were available in the home. It is a requirement of this report that the home obtains copies of these documents and that a policy relevant to the home is developed and discussed fully with all staff. It was of concern to the inspector that separate discussions both with some members of staff and the manager found that they thought that a recent course undertaken by some staff about the management of challenging behaviour meant that they had covered all that was needed to be known about abusive practice. The manager was required to organise an appropriate course for abuse training for all staff and herself without delay. This was a previous requirement and no action has been taken by the home. The course on ‘dealing with challenging behaviours’ referred to above had been undertaken by four staff. Whilst this is a start, this training is required for all staff and the manager must also ensure that the remaining two staff receive this training. Additionally the manager must consider the comprehensiveness and relevance of the training received by the four staff to see if it was appropriate for the needs of the service users at the home. The requirement is that all staff are trained in the management of challenging behaviours to the level required for staff to understand and meet the needs of the service users. The home acts as appointee for all of the service users and their benefits. On looking at the finances for the two service users who have lived in the home for approximately 11 months now it became clear that the manager had no understanding of the amount that each should contribute to their care, even though this was clearly shown in the contract formed between the service user, home and Stoke-on-Trent County Council. This had resulted in one of the service users having to recently pay back £5000 in arrears to the proprietor. Examination of the finances of the other service user showed that she was approximately £1000 in arrears that the manager was only now trying to sort out. A requirement has been made earlier in this report under the heading of ‘Individual Needs and Choices’ that the records for service user finances are independently monitored. It is a further requirement that the manager receives some training on understanding the financial procedures for payment of fees by the service users. A sample of the same two service users’ records relating to expenditure and record keeping for their personal finances were examined. Staff support both service users with their finances when going out shopping, to pay bills etc. There was a clear system in place for all monies taken out of the home for each person, and recording of expenditure, money returned and monitoring of balances. The samples checked were in order and there were receipts in place to cover the expenditure. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 24 Examination of the bank books of the two service users showed that £126.19 had been paid out of one account a month previously for a gas bill at the previous home, and the other service user although owing half of this bill had not yet been supported to pay back the other resident for his half. The time lapse of one month is not acceptable, and without this having been found at the inspection may not have been noticed at all. In addition there was no receipt for the payment of the bill to provide an audit trail. It was only the manager’s recollection that the amount paid out was for the payment of the bill discussed above. The manager was required to ensure that the resident be paid the outstanding amount without delay. A further requirement, again without delay was made that the bank be contacted to see if evidence of the bill being paid could be provided. These matters will be checked out with the manager by telephone and at the next visit to the home in one month’s time (from the date of the visit of 2 May), which is on her return from holiday. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 25 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained and has responded well and timely to the requirements of the fire service. This means that the safety of the service users is better assured. EVIDENCE: Chatterley House is a pleasant home. It provides spacious accommodation for nine service users in a domestic style with comfortable furniture and fittings and good décor in a very homely environment. There is a spacious lounge, separate dining room with a large conservatory off, well equipped kitchen, sufficient bathrooms for the nine service users, with five single and two shared bedrooms that are well furnished. The laundry is sufficient to meet the service users needs. The premises provide sufficient light, heat and ventilation. The grounds are spacious and well cared for with an attractive summerhouse. The Fire Officer made a visit during March 2006 and found that several improvements were needed to the fire systems to best ensure the safety of the Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 26 service users. A meeting was held a short time later with the proprietor and the manager about other matters, but the Fire Officer was invited to part of the meeting to further discuss the improvements he required. The Fire Officer and the Commission were pleased to hear at this meeting that the majority of the improvements had already been addressed. At this inspection a tour was made of the premises. Observation confirmed that the majority of the remedial work had been completed, save for new holding arms were needed on two doors and a pictogram sign for the rear/outside door was still required. The home has been required to address these omissions. The manager was unsure about an issue regarding the loft and she was also required to check out with the Fire Officer the requirements for this area. It was also required that she check with him that the certificate of installation and commissioning provided by the electrician was sufficient for purpose. Other areas of the fire officer report are discussed later in the report under ‘conduct and management of the home.’ It was disappointing to find that the hoover had been placed by the laundry door to hold it open. This is a fire door with a dorguard retaining unit and in the event of fire the placement of the hoover would cause some obstruction. The manager removed the equipment immediately and is required to bring to the attention of all staff the requirements of the Fire Officer and the need for health and safety awareness in the home at all times. The home does not have a planned maintenance and renewal programme for the premises and accompanying records, and this is required. In the past issues have been raised by the Commission such as the upgrading of bathrooms and bedroom furniture and whilst they have been responded to speedily, the home should not rely on the Commission to bring such issues to their attention. The need for monthly unannounced visits by the provider when the environment as well as other issues need to be professionally discussed is addressed later in the report. The tour of the premises covered all communal areas of the home and 3 bedrooms. Everywhere was very clean and tidy. The home has previously confirmed in writing to the Commission that the laundry facilities and policies and procedures carried out in the home are appropriate for the control of infection. Four staff have received training in infection control and it is recommended that the remaining staff also complete this. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are insufficient to meet the needs of the service users on a consistent basis and could put their safety at risk. Mandatory training for staff is also poor. EVIDENCE: The service users at Chatterley House like all of the staff and this was stated in the comment cards received and in individual discussions with two of the service users. The relatives’ comment cards received were all positive. A Community Nurse for Learning Disability returned a comment card and the statements within this were also positive. ‘Staff have always been efficient and helpful in their advice and support and in following planned episodes of monitoring of care.’ The team of staff at Chatterley House is small. A number of staff have worked there for a considerable period of time and have a good understanding of the needs of the service users, and as is necessary with only a small staff team they undertake additional hours to cover vacancies, holidays and sickness of Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 28 their colleagues at short notice. Two newer staff were interviewed and the inspector was impressed with their commitment and enthusiasm. Reference is made elsewhere in this report to the lack of interaction observed between staff and service users. This is not a reflection on staff attitudes generally, but whenever the inspector is at the home the staff always seem to be busy with other jobs, either cleaning, laundry or cooking, and this is not usually because they are supporting the service users with these tasks which would be more positively viewed. A later section of the report refers to the requirement to employ waking night staff, and it is anticipated that these new staff will undertake some of the household duties during the night which should assist the day staff to concentrate more on supporting the service users. It is highlighted later in this report that staff are not always provided with the necessary training to equip them to meet all of the needs of the service users. The home has a lack of awareness of Learning Disability Award Framework training and the benefit of this for staff working in the service to gain this underpinning knowledge before proceeding to NVQ 2 training. The manager was required to research the availability of the providers of this training in the local area. The home works well at providing training for care staff to NVQ Level 2 and above. Currently one worker has NVQ 3, one is working towards NVQ 3, one has NVQ 2, two are working towards NVQ 2 and one is waiting a start date. This means that 50 of the staff are qualified to NVQ 2 or above. There have been concerns in the past regarding the small number of staff available. This concern is added to by the fact that the staff team also cover another home for two service users that is close by. These service users spend part of their week at Chatterley House because of the staffing issues. The manager advised that there are currently six staff employed, with one vacancy. This is to provide cover at both homes. There has been a vacancy for some time, which the home is finding it difficult to fill. The duty rotas were seen at this visit and showed that there was generally two staff planned for each shift with one ‘sleep in’ staff. However due to the vacancy there are four days within the week when only one member of staff is on duty between 5pm and 10pm for nine residents. This puts the safety of the service users at risk should any untoward incident occur. Since the last inspection visit the two newer service users have undertaken more outside activities as the member of staff who was employed for this purpose has been deployed to provide support to enable this. This though has now had a ‘knock on’ effect causing the low level of support for the evening hours as described above. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 29 The manager has received some applications from interested applicants to work at the home and was required to undertake interviews without any further delay to try to address the staffing shortfall. Night cover at the home has recently been discussed with the proprietor and the manager following concerns expressed by the Fire Officer regarding overnight safety of the service users, especially with the availability of only a sleep in member of staff. It was agreed that two new staff would be recruited to work as waking night staff, one member of staff each night. This would also have the added advantage that the staff rota would be more flexible as the current staff would not need to provide the sleep in cover. It was disappointing to find that there had been no further progress on this, and the home is required to advertise for the waking night staff without further delay. The recruitment procedure followed by the home was discussed with the manager and three staff files were looked at. There was no photograph of the member of staff on any file, only one file contained any proof of identity, an application form was missing from one file, one file had only one reference, and there was no POVA First or current CRB for one staff member. All had confirmation of their induction process having been completed and a record of their training. Concern regarding the thoroughness of the recruitment procedures undertaken by the home was added to by the fact that there had been no POVA check/CRB undertaken on a new casual worker in the home, in spite of the fact that the manager had been firmly required by the Commission when the worker had been discussed to obtain such checks prior to the person joining the home. It is no excuse that the person was previously well known to the proprietor and the manager. The manager is required to ensure that thorough recruitment procedures are in place in the home, and attention is also drawn to Schedule 2 of the National Minimum Standards for Younger Adults to act as a part check- list for the requisite information. It is also required that the casual worker undertakes no further work in the home until a satisfactory POVA First check is received, that this check is also obtained for the member of staff with an out of date CRB and that no-one else works in the home until a satisfactory POVA First check is completed. The induction process for new staff was discussed. The manager was unable to state whether the induction training meets the Skills for Care specification. The manager was required to seek clarification regarding this issue and up date the induction training followed in the home should this be found necessary. Two staff were spoken with and they confirmed that they had undertaken an induction programme that they felt was thorough. The response to the need for NVQ training is not followed through in other areas of mandatory training. The home does not have a training and Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 30 development plan in place or dedicated training budget. Additional training, apart from infection control and some local District Nurse training appears only to be taken up following requirements by the Commission. The Statement of Purpose for the home states that staff have the required mandatory training but the evidence does not support this. The home is required to provide Basic Food Hygiene training, or refresher training where this is applicable, for all staff that prepare food. The home is required to provide abuse training for all staff (also covered under the section on protection). The home is required to provide Moving and Handling training for all staff. The home is required to provide Basic First Aid training to the remaining staff who currently undertake duties without any other qualified person being available. The home is required to provide fire training for all staff. The home is required to ensure that medication training recently received is to the appropriate level (also covered under the section on personal and healthcare support). The manager was required to obtain dates for all of these training courses within a month of the visit. (It is recognised that the actual training may not have taken place within this timeframe). This was a requirement of the previous inspection and little progress has been made since that visit in February 2006. Discussion with two staff evidenced a lack of underpinning knowledge about equality and diversity and their meanings, although prompting did gain some positive responses. Neither of the staff had completed their NVQ 2 and their understanding will be tested out at a further inspection as their training progresses. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 31 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Insufficient time to devote to management tasks and a poor understanding of the national minimum standards and regulations by the manager affects the running of the home. Better relationships between the manager and the provider are also needed to ensure that the home is run in the best interests of the service users. EVIDENCE: The Registered Manager has been managing the home for some considerable time now and she has also gained her NVQ4 and Registered Managers Award. She has overall responsibility for running the home, which is set out in a job description. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 32 It has been discussed with the manager over a long period that whilst being available to cover the rota and to take part in the provision of care is important, more time was required to fulfil the other managerial duties that are required in running the home. This happens for a period and then because of staff shortages falls away again. The home has a history of showing some improvement following an inspection and then standards fall again somewhat by the next visit. It has been discussed with the manager and the proprietor that this cannot continue. The manager states that it is the problem of staffing that means that she cannot complete her managerial duties, and whilst this is agreed with to some extent evidence also suggests that the manager is slow to take action in some areas that would help her in freeing up some of her time. For example she has acted as a taxi service for service users who have allowances to cover the cost of public transport, which would also assist their independence if pursued via a risk assessment framework. More recently the proprietor has suggested further help from another competent person with the office work and this has only been followed through to a limited extent. Both the manager and the proprietor must take some responsibility for this if the situation is to improve. Additionally during discussion the manager agreed that she had only a limited knowledge of the standards and requirements under the Care Standards Act and a requirement of this report is that she takes action to improve this knowledge so that the service users can benefit from a well run home. Two of the service users living in the home are over the age of 65 years. The home is therefore required to apply for a variation of their registration as they are only currently registered for nine Younger Adults (18-65 years). This is a requirement of this report. The Commission has had a number of recent meetings with the proprietor and the manager regarding concerns about the lack of a professional relationship between them. It had became apparent during an additional visit to the home that they were not speaking but rather conducting the business of the home by ‘message carrying’ by staff and service users. It has been made clear that this is not acceptable and both parties are required to conduct business between them in a professional manner. This is a requirement of this report. Since the deterioration in the relationship, whilst the registered provider has been visiting the premises there has been no full liaison with the manager and examination of records and no formal discussions with staff and service users about the standard of care in the home as is required by the regulations via a monthly unannounced visit. The requirement is that these visits are made and that a report is provided to the Commission on the outcomes. Because of difficulty in meeting the standards in a number of areas a focus on quality assurance and effective quality monitoring has a low priority. However, to balance this statement the home does hold regular meetings with service Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 33 users to ask their views about issues in the home and a basic service user survey has been drawn up in readiness to distribute to service users. The views of relatives who returned comment cards to the Commission were positive about the outcomes being achieved for each of their relatives. The home is required to distribute the survey forms that have been drawn up and to analyse the results and make these available to the service users, their representatives and to the Commission. Mention is made earlier in the report that the staff have not been trained in moving and handling and there are no moving and handling assessments available. These have been made a requirement of this report. The Fire Officer’s report highlighted shortfalls in fire safety in the home, not only in the environment but also in other important areas: - A fire risk assessment needs to be completed for the premises; - Individual risk assessments need to be completed for all of the service users (this has been attempted but the information needs expanding upon); - A ‘vibrating pillow’ for one service user who is hard of hearing was agreed to be purchased; - The Fire Procedure giving instruction for staff needs to be expanded; - Better fire training is required for all staff; - A pictogram sign is required for the rear outside door; - Better recording of what is covered in fire training and fire drills is required; - An effective planned preventative maintenance programme for fire safety needs to be developed. These issues are outstanding and are all requirements of this report. An Emergency Contingency plan has been drawn up since the visit. Arrangements for staff who smoke have been changed since the visit and a revised Smoking Policy is required so that staff are clear about what is and what is not acceptable. Issues regarding a lack of training of staff in first aid and food hygiene have been highlighted earlier in the report under ‘staffing.’ The home maintains appropriate records for ‘fridge, freezer and cooked food temperatures (food probe readings). All COSHH (Control of Substances Hazardous to Health) were stored appropriately in a locked cupboard. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 34 There were up to date certificates in place for the safety of gas and electric installations. However, no PAT (Portable Appliance testing) had been carried out and this is a requirement of this report. Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 35 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 1 X 1 X 2 X X 2 X Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 36 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 YA1 Regulation Requirement Timescale for action 02/08/06 4, 6 and Redraft the Statement of Schedule 1 Purpose to contain all of the information as required by the standards and regulations and schedule (This is a previous requirement) 5, 6 2. YA1 3 YA6 15 and Schedule 3(1)b Redraft the Service User Guide 02/08/06 to contain all of the relevant information about living in the home that the service users may require (This is a previous requirement and has been partially met) Improve the care plans to 02/08/06 ensure more complete information about each service users needs and preferences is available. (This is a previous requirement) The home must ensure that the records for service user finances must be independently audited/ monitored. 30/06/06 4 YA7 20 (3) 25(3)a Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 37 5 6 YA14 YA16 16 (2) m, n 12(4)a 7 YA17 16(2)i 8 YA17 16(2)h 9 YA18 13(5) 10 YA18 13(5) 11 YA20 13(4)c 12 YA20 18(1)c 13 YA22 22(4) Ensure that service users are supported to maintain their interests and hobbies Provide a lockable facility for the service user who expressed a wish for this, and as highlighted to the manager at the inspection Keep a record of alternative choices available to service users if they do not wish what is offered on the menu at a meal Involve the service users in the planning of meals, and where appropriate to their care plan, in the preparation of meals. Ensure a safe system for moving and handling service users, including a moving and handling risk assessment Maintain a working record of the preferred routine, likes and dislikes of the service user who cannot easily communicate her needs and preferences (this would be good practice for all service users) Ensure that unnecessary risks to any service user are identified and as far as reasonably practical eliminated. (This refers to all known areas of risk and medication and its monitoring in particular in this instance) Provide training for all staff that administer medication, external to the home and that is formally assessed. (This was a previous requirement and has only been partly addressed. The manager must satisfy herself that the medication training is to an appropriate level) Amend the Complaints Procedure to contain the timescale of 28 days for the complaint to be responded to. (This has been a requirement DS0000008209.V290608.R01.S.doc 02/06/06 02/06/06 02/06/06 02/07/06 02/07/06 02/08/06 02/05/06 02/06/06 02/08/06 Chatterley House Version 5.1 Page 38 14 15 YA22 YA23 22(8) 13(6) 16 YA23 13(6) in the past and the Commission was advised that this had been addressed) Maintain a record of all issues 02/05/06 and complaints made by the service users Obtain a copy of the local 02/05/06 authority inter-agency procedures for the protection of vulnerable adults and a copy of the Department of Health publication entitled ‘No Secrets.’ Provide training for staff about 02/05/06 abusive practice and the safeguarding of service users (This was a previous requirement and has not been addressed) Provide training in behaviours that challenge to a level suitable to meet the needs of the service users, for the remaining staff Ensure service users finances are appropriately managed on their behalf and that a receipt is kept for every payment made. Ensure that there are sufficient staff available to meet the needs of the service users and to ensure their safety Commence recruitment of waking night staff as previously agreed with the Commission Ensure POVA First checks are in place before any new staff commence working in the home, with regular monitoring until the follow on CRB check is received. (Recent CRB checks from a previous employment are NOT acceptable) Obtain 2 written references for each new staff member before they commence employment Ensure that all of the information referred to in schedule 2 is retained for every DS0000008209.V290608.R01.S.doc 17 YA23 13(7) and (8) 20 and Schedule 4 18(1)a 02/06/06 18 YA23 02/05/06 19 YA33 02/05/06 20 21 YA33 YA34 18(1)a 19 and Schedule 2 02/05/06 02/05/06 22 23 YA34 YA34 19 and Schedule 2 19 and Schedule 2 02/05/06 02/06/06 Chatterley House Version 5.1 Page 39 member of staff 24 YA35 18(1) c Obtain verification that the induction training provided for staff meets Skills for Care specification Research the provision of Learning Disability Award Framework training (LDAF) towards providing this training as underpinning knowledge for all staff Provide Basic Food Hygiene training, or refresher training where this is applicable, for all staff that prepare food. Provide moving and handling training for all staff (This was a previous requirement) Provide first aid training for all relevant staff (This was a previous requirement) Provide fire training for all staff to the level agreed by the Fire Officer The manager must improve her knowledge of the information contained in the Care Homes for Adults (18-65) National Minimum Standards and accompanying regulations The manager must undertake some training to ensure her understanding about the fees that the service users pay to the home Ensure that the training matrix shows the dates when training was completed and also for when any refresher training is due(This was a previous requirement and has been only partially met) 02/06/06 25 YA35 18(1)c 02/06/06 26 YA42 16(2)j 02/05/06 27 YA42 13(4) (5) 02/05/06 28 YA42 13(4)c 02/05/06 29 30 YA42 YA37 23(4) (5) 9 (2)(b)i 02/05/06 02/05/06 31 YA37 10(3) 02/06/06 32 YA35 18(1)c 02/06/06 Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 40 33 YA37 34 YA37 9 and Fees and frequency regulations 12(5)a 35 YA43 26 36 37 YA42 YA42 23 (4) 23(4) Apply to the Commission for a variation to the registration of the home for 2 residents over the age of 65 years The registered manager and registered provider must maintain good professional relationships with each other The provider must make a monthly unannounced visit to the home and a report must be provided to the Commission on the outcomes. (This has been a previous requirement and compliance has lapsed) A fire risk assessment needs to be completed for the premises; Improve individual risk assessments for all of the service users in relation to fire Purchase a ‘vibrating pillow’ for 1 service user who is hard of hearing as previously agreed Improve the Fire Procedure giving instruction for staff as discussed with the Fire Officer Provide an improved schedule of in-house fire training and fire drills Maintain a planned preventative maintenance schedule for the fire system as discussed with the Fire Officer Provide a Smoking Policy for staff to make them aware of where they can and cannot smoke Provide a pictogram fire sign for the rear outside door as discussed with the Fire Officer Ensure Portable Appliance testing (PAT) is undertaken DS0000008209.V290608.R01.S.doc 02/06/06 02/05/06 02/05/06 02/06/06 02/05/06 38 YA42 23(4) 02/05/06 39 YA42 23(4) 02/05/06 40 41 YA42 YA42 23(4) 23(4) 02/05/06 02/06/06 42 YA42 23(4) 02/08/06 43 44 YA42 YA42 23(4) 13(4)a 02/05/06 02/06/06 Chatterley House Version 5.1 Page 41 45 YA42 13(4)c On no occasion must any service user be left in the home alone (This was an immediate requirement) 02/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard YA13 YA6 Good Practice Recommendations Consider providing a notice board to show local amenities, facilities, advocacy services, complaints procedure etc Move to recording the service user plans in a person centred planning format to enable the service users to better understand their plans and to provide a focus on the service users individual needs Discuss with the relevant service user and his Social Worker about his negative views of living at the home 3 YA7 Chatterley House DS0000008209.V290608.R01.S.doc Version 5.1 Page 42 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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