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Inspection on 21/11/06 for Chatterley House

Also see our care home review for Chatterley House for more information

This inspection was carried out on 21st November 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents like living at the home. At this and other visits they said that the staff are kind and helpful to them. One resident who does not speak smiled when the staff names were mentioned and her face `lit up` when staff came into the room. 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. The home was not meeting the residents` needs well at the last inspection, and record keeping was not good. There have been some good improvements and these are listed in the next section.

What has improved since the last inspection?

At the last inspection the home was not keeping good records about the needs of the residents. This meant that care might not have been provided consistently. Although the plans need reviewing more regularly there was more information available about each person this time. There was some confusion last time about the fees that the newer residents have to pay and 2 people were in arrears with their care payment, which meant that they had bills to pay that they were not aware of. This has been addressed and everyone`s finances are up to date. Residents` individual finances have been audited independently to make sure that they are correct. There were poor records about the risks to residents when they went about their daily lives, such as going out alone. This also included no details about whether they needed support in using the bath for example. These records are much better now. Training for staff has been an issue. Staff need the appropriate training to enable them to assist the residents in a proper way and to keep them safe. Most of the mandatory training has now been provided and courses are arranged for the outstanding areas about the protection of vulnerable adults from abuse, and about how to respond to challenging behaviour. The induction training for new staff has also been improved. Staff recruitment was not as good as it should be at the last visit. This meant that references were not always taken up before staff had started, not all staff had criminal records clearance before they started work, or the home had not checked that staff were physically and mentally fit to work at the home. All these issues have been addressed. Fire safety required improvement to comply with new fire regulations that came into force in October of this year. The home has done what the fire officer asked and he has recently said that the home now meets the new regulations.

What the care home could do better:

The improvements in the home were pleasing to note. There do however remain some areas that have not been properly addressed: Not all of the residents take part in all of the activities that they would wish. This includes going to Stoke City football match for 1 resident and to church for another. These activities had been enjoyed at their previous placement and the home was required at the last visit to take this on board. The residents have still not been to these activities, which is disappointing. The home has been required to address this. The home has not responded properly to the health needs of 2 residents. For one this means that he has not been referred to specialist health services to see if they can help with his behaviours. They have been required to meet the health needs of all of the residents, including referral to specialist services in a timely way where this is needed. At this inspection it was found that soiled linen was not being dealt with appropriately which meant that the risk of the spread of infection was not being reduced as much as it should. The manager has been required to address this.The staffing arrangements mean that at times there is insufficient staff for the residents to undertake the activities that they would like to, as mentioned earlier. The owner is taking steps to address this by closing another home that is close by and moving the residents and staff from that home to Chatterley House. The commission considers this to be helpful, but will monitor the staffing arrangements to ensure that there is an effective staff team in place at all times. Linked to the extension that is being built to provide bedrooms for the 2 residents that will be moving into the home from the one that is closing, the owner and manager have not taken sufficient care in managing this, so that 1 of the residents has not had access to his bedroom for a few weeks. This has been managed by alternative arrangements but should and could have been prevented completely if sufficient care had been taken initially. The owner and manager are required to manage the home with sufficient care, competence and skill.

CARE HOME ADULTS 18-65 Chatterley House Chatterley Road Tunstall Stoke-on-trent Staffordshire ST6 4PX Lead Inspector Irene Wilkes Key Unannounced Inspection 21 November 2006 09:00 Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 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.V320678.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V320678.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chatterley House Address Chatterley Road Tunstall Stoke-on-trent Staffordshire ST6 4PX 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), Learning disability over registration, with number 65 years of age (3) of places Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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.V320678.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a day by 1 inspector. 4 residents were spoken with at some time during the visit. The other 5 residents were on holiday. Comment cards were not received from the residents at this visit, although they had been returned for the inspection in May of this year. 3 care plans and 3 staff files were looked at. Other documents about the running of the home were also seen, including those about staff training, menu plans, medication and maintenance records. 2 staff on duty were interviewed and discussions held with the manager when she came on duty later in the visit. Staff practice, including how the staff talked and supported the residents was observed throughout the inspection. No friends or relatives visited at this inspection. 2 of the residents are over the age of 65 years. There is a special report that can be completed where residents are from different age groups. That report has not been used on this occasion as it is considered that the areas looked at for younger adults with learning disabilities apply better to this home. What the service does well: What has improved since the last inspection? At the last inspection the home was not keeping good records about the needs of the residents. This meant that care might not have been provided consistently. Although the plans need reviewing more regularly there was more information available about each person this time. There was some confusion last time about the fees that the newer residents have to pay and 2 people were in arrears with their care payment, which meant that they had bills to pay that they were not aware of. This has been Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 6 addressed and everyone’s finances are up to date. Residents’ individual finances have been audited independently to make sure that they are correct. There were poor records about the risks to residents when they went about their daily lives, such as going out alone. This also included no details about whether they needed support in using the bath for example. These records are much better now. Training for staff has been an issue. Staff need the appropriate training to enable them to assist the residents in a proper way and to keep them safe. Most of the mandatory training has now been provided and courses are arranged for the outstanding areas about the protection of vulnerable adults from abuse, and about how to respond to challenging behaviour. The induction training for new staff has also been improved. Staff recruitment was not as good as it should be at the last visit. This meant that references were not always taken up before staff had started, not all staff had criminal records clearance before they started work, or the home had not checked that staff were physically and mentally fit to work at the home. All these issues have been addressed. Fire safety required improvement to comply with new fire regulations that came into force in October of this year. The home has done what the fire officer asked and he has recently said that the home now meets the new regulations. What they could do better: The improvements in the home were pleasing to note. There do however remain some areas that have not been properly addressed: Not all of the residents take part in all of the activities that they would wish. This includes going to Stoke City football match for 1 resident and to church for another. These activities had been enjoyed at their previous placement and the home was required at the last visit to take this on board. The residents have still not been to these activities, which is disappointing. The home has been required to address this. The home has not responded properly to the health needs of 2 residents. For one this means that he has not been referred to specialist health services to see if they can help with his behaviours. They have been required to meet the health needs of all of the residents, including referral to specialist services in a timely way where this is needed. At this inspection it was found that soiled linen was not being dealt with appropriately which meant that the risk of the spread of infection was not being reduced as much as it should. The manager has been required to address this. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 7 The staffing arrangements mean that at times there is insufficient staff for the residents to undertake the activities that they would like to, as mentioned earlier. The owner is taking steps to address this by closing another home that is close by and moving the residents and staff from that home to Chatterley House. The commission considers this to be helpful, but will monitor the staffing arrangements to ensure that there is an effective staff team in place at all times. Linked to the extension that is being built to provide bedrooms for the 2 residents that will be moving into the home from the one that is closing, the owner and manager have not taken sufficient care in managing this, so that 1 of the residents has not had access to his bedroom for a few weeks. This has been managed by alternative arrangements but should and could have been prevented completely if sufficient care had been taken initially. The owner and manager are required to manage the home with sufficient care, competence and skill. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 8 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.V320678.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have an assessment of their needs before they are offered a place in the home. EVIDENCE: The evidence from previous inspections has shown that residents’ needs are appropriately assessed before they move into the home. There have been no new admissions since the last inspection and therefore this standard remains met. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to make decisions about their lives with an informed choice about taking risks, but the records kept about their individual plans and their assessed and changing needs require improvement. EVIDENCE: The care plans showed some improvement since the last inspection. In the 3 files sampled the plans had been developed from the initial needs assessment and there was better information about how individual needs should be met, such as responses to some limited challenging behaviour. However the plans are in written format that the majority of the residents cannot understand, and one of the plans had not been reviewed in the last 6 months. Additionally the files for each resident that were seen were a little confusing and it was difficult to find the most up to date information. Some staff were also using a particular form to record reviews, whereas others were not. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 11 The home is required to review the care plans of each resident at least every 6 months, or more frequently if the circumstances and needs of the resident change. It is recommended that the information in the care plans be kept in a more orderly way. The manager has been researching ways to make the care plans more user friendly for the residents and it is recommended that this continue. One of the residents does not speak. While her key worker has in the past indicated to the commission how she interprets facial expressions and gestures her care plan does not have any specialist communication needs of the resident written down or show the methods of communication with her. It is a requirement that such detail is recorded. This could be by way of a log to show, for example, ‘when x frowns, we think this means she does not like e.g. the choice of food, what is being said’ and such like. A number of residents spoke to the inspector about their lives. The majority of the residents have lived in the home for some time and they continue to make their own decisions about lifestyle, such as one having a relationship with a lady friend, attending sheltered employment and travelling independently. The home acts as appointee for all of the residents for their state benefits. Evidence noted at a previous inspection that the manager had a poor understanding about benefits, and the assessed charge that had been calculated by Social Services that the residents individually had to pay. This had resulted in 2 residents being in arrears and having to pay these quite large amounts back. It has been found via monitoring visits to the home that the manager has since taken advice about finances and has improved her understanding. It was evidenced at this inspection that the requirement that had been made for all of the residents’ financial records to be independently audited had been met. The home has always supported the residents to lead an independent lifestyle and previous inspections have evidenced through discussions with the residents that staff talk to them about issues such as personal safety, road safety, and spending money wisely and travelling independently. However this has not always been written down in the past. At this visit there was a considerable improvement seen in the 3 records sampled about the risks that had been discussed with the residents and the control measures that had been identified to minimise the risks as far as possible. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While the home provides good support for those residents who wish to take part in structured education, and welcomes all the residents’ visitors into the home, they are still not meeting the assessed lifestyle needs of the 2 newer residents. EVIDENCE: The majority of the residents who have lived at the home for some time are all engaged in meaningful activities that they have taken part in for some time. Some attend day services and college, one gentleman works in sheltered employment and one of the ladies works as a volunteer in a charity shop. The home has always supported the residents to engage in these occupations. Other residents have made the choice not to attend any further education or training opportunities. One gentleman who is over 65 years of age prefers to stay in at home, apart from going to his local pub independently for a drink on some lunchtimes. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 13 At the last inspection there had been some improvement by the home to meeting the needs of the newer residents. In their former placements they had enjoyed going out every day and although the home were still falling short of this there was evidence that they were going out for meals and shopping, and this has continued. However, at the last visit one of the newer residents told the inspector that he still had not been to watch his football team, Stoke City play, and he wanted to go very much, as he had been used to going previously. This resident was on holiday at this visit but his records showed no evidence of him having attended a football match, and a staff member confirmed that he had still not been, although a visit was planned with another resident and staff. The assessment information for another resident stated that she enjoyed attending church on a Sunday. She has still not attended since moving into Chatterley House. The manager said that she did not think she would be very interested in going. The lady does not speak and the home had not actually taken her to church to see if she enjoyed it. It was discussed with the manager that the staffing levels were again preventing the residents from maintaining their interests and hobbies. Issues about staffing are discussed in more detail under the outcome group of staffing. The home is required to make arrangements to enable all residents to engage in social and community activities of their choice. The home is very good at supporting the residents to maintain family links and friendships. The residents who have relatives said that they see them regularly, and one resident who has a lady friend said that the staff invited her to tea with him, and he also visited her at her home. Another resident said that his sister visited almost daily and was always made welcome. The 2 newer residents have also been supported to maintain contact with a lady with whom they used to live. The daily routines of the home are flexible to allow residents to make their own choices about getting up, going to bed and the general pattern of their day. When the inspector arrived, 3 people had already left the home for college, 1 was preparing to go to work and another lady was having her breakfast before having her shower. The lady does not speak, but staff said that she indicated to them each day whether she wanted her breakfast first or after showering/bathing. Staff were seen to observe the privacy of the residents by knocking on their bedroom doors before entering, and they talked to them generally in a respectful way. (An incident where the staff response was not so good is Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 14 referred to under staffing). The residents who were at home spent the day ‘doing their own thing’. It was pleasing to note that one of the staff engaged 2 of the residents in playing dominoes, and this also led to another enjoying the fun by watching. This was an improvement on previous visits, and was clearly enjoyed by the residents. The residents have always said that they enjoy their food at the home. Two residents who were asked at this visit said that ’its still good.’ The lunch at the visit was cheese and tomato toasty and each person said that they had enjoyed it. The menu plans showed a cooked meal for tea. There was evidence that a choice was offered should anyone not wish the main meal on offer. At the last inspection the commission found that the residents would like more involvement in decision making in the home. A requirement was made about this. This had been taken on board by the time of this inspection in respect of menu planning, and the residents said that they sit down and choose each weekend what they would like to eat the following week. Those asked said that they enjoyed doing this. The progress made was noted. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home must improve its responses to meeting the health care needs of residents in a more timely way. EVIDENCE: Information about the support needs of the residents and the way in which they prefer the support to be provided was poor at the last inspection. There were no moving and handling risk assessments. Whilst the residents overall generally only require prompts for personal care needs, and no-one requires any aids or adaptations, there was previously no information on file showing this. These omissions had been addressed at this inspection in the 3 files sampled meaning that the records showed a clear improvement. One of the residents does not speak, although it is considered that she can understand what is said to her. It was noted that a plan of care has now been written for the way in which it is considered that the resident prefers support to be provided. This was missing at the last inspection and is an improvement. The residents all have a key worker, which they are pleased about. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 16 The home has a good history of supporting the residents to gain access to health services and they also ensure that any follow up action required is addressed. The care plans inspected at this visit showed appropriate recording of all health appointments, health checks, issues and outcomes for each resident. However, one of the files showed that following a GP appointment in July this year the home had been asked to support a resident to manage her weight. A weight chart had been set up but this showed only an initial record following the GP visit. The manager’s explanation was that the scales were broken. This is not satisfactory. The manager is required to ensure that the home makes proper provision for meeting the heath needs of service users. In this case this is to ensure that the particular resident is weighed regularly and a record kept of her weight on every occasion, with the weight notified to the GP if there is any cause for concern, i.e. weight gain. During the morning of the visit an incident arose with a resident that indicated that he might require some support from the psychiatric services/behavioural services. This was discussed with the manager who said that she had not considered this. The manager is required to make arrangements for the resident to receive treatment or advice from the relevant health care professional. Arrangements for the receipt, storage, handling, administration and disposal of medication were satisfactory. The home uses the monitored dosage system for medication. This medication was appropriately stored in the medication cupboard that is fastened to the wall of the office. The office is locked when not in use. The MAR (Medication Administration Records) were examined and for one resident there were gaps in recording for 1 of his tablets for 4 days. The manager said that on one day she was in charge of medication and the resident had definitely received all of his tablets. She could offer no explanation for the gaps in the recording. The medication was not in the dosette box and it therefore had to be assumed that the tablet had been taken. The manager is required to ensure that appropriate recording is maintained in all instances for all medication. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The manager needs to ensure that appropriate training is provided and understood by staff about what abusive practice is, to assure herself that residents are protected from abuse, neglect and self harm. EVIDENCE: Residents are provided with a copy of the complaints procedure and a copy is also pinned to the notice board in the entrance hall. The procedure has been improved since the last visit to now comply with the standards. A resident explained to the inspector what he would do if he was not happy with something and he had a good understanding of his right to complain and how this would be addressed. No formal complaints had been made to the home. The commission has not received any complaints about the home. At the last visit a requirement was made that minor grumbles or incidents should be recorded to show an audit trail of how such issues were being responded to. This had been addressed by the time of this visit, and 2 issues of disputes between 2 residents were recorded. These showed appropriate investigation and outcomes. The home has a poor history of training staff about the understanding of abuse, extending to not even having any appropriate procedures or information for the staff to read about safeguarding vulnerable adults. It had been made clear to the manager that this was not acceptable and during follow up monitoring visits it had been evidenced that the Department of Health Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 18 publication entitled ‘No Secrets’ had been obtained, and additionally the Staffordshire multi agency procedures for the protection of vulnerable adults were now also available. The manager is recommended to obtain evidence for herself that these have been read and understood by staff. It was disappointing to note that training for staff about the protection of vulnerable adults and about responses to challenging behaviour for some staff had still not been provided. To balance this statement the manager did present evidence to show the avenues that she had tried to source this training, and following the inspection and before this report was written a telephone call was received stating that training in both of the above mentioned areas had been booked. The commission will monitor that this training has taken place. The manager is recommended to obtain evidence for herself that the staff have understood the training that is provided. There were issues at the last inspection regarding record keeping of 2 residents’ finances. Evidence was seen that this has been addressed. There was no further inspection of residents’ finances undertaken at this inspection. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation provides a comfortable and safe home for the residents but laundry procedures need to be improved. EVIDENCE: Chatterley House provides spacious accommodation for 9 residents in a domestic setting with comfortable furniture and fittings and good décor. There is a spacious lounge, separate dining room with a large conservatory off, well equipped kitchen and sufficient bathrooms for the 9 residents. The Fire Officer made a visit during March this year and found that several improvements were needed to the fire system. The home has responded in a timely way to ensure that both the physical improvements needed and the risk assessments and staff training have been addressed. The Fire Officer had made a follow up visit just before this key inspection and has since confirmed that he is now satisfied with the fire safety within the home. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 20 There is building work in progress to extend the home with 2 additional bedrooms with en suite facilities. This is to accommodate 2 further residents who currently live at the sister home of Chatterley House, about a mile away. That home is to be closed. There were documented risk assessments in place to show that the hazards presenting on site with the building work had been considered and were being appropriately managed. A tour was made of the building and the grounds and there were no areas that presented as a concern. An issue has arisen, however, about the lack of understanding by the owner and manager about the building plans. This is addressed under the outcome group of ‘conduct and management of the home’. It became apparent during the visit that the home is not following appropriate laundry procedures for washing soiled linen. This is in spite of the manager having received a copy of a document produced by the local health trust regarding infection control that specifies the correct procedures to be followed. The majority of staff have also received training in infection control measures and it is disappointing that these issues have not been identified within the home. The manager is required to introduce appropriate procedures for the handling of soiled laundry. The manager is also required to consult the environmental health department /manufacturer of the machine to assure herself that the washing machine is suitable to wash soiled laundry at appropriate temperatures, i.e. minimum 65 degrees for not less than 10 minutes, and has the specified programming ability to meet disinfection standards, if this is needed to meet the residents’ needs. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 21 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. 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 need to be improved so that the needs of all of the residents can be consistently met. EVIDENCE: The resident’s spoken with at this and previous visits all said that they like the staff and that they are good to them. Throughout the visit there was generally a good rapport between the residents and staff when staff showed a good understanding of each individual’s needs. 2 staff were also asked about individual residents and they spoke knowledgably about how they supported them. A response to a particular incident with a resident however highlighted that some staff do not have the proper awareness of how to manage challenging behaviours or circumstances. A resident was spoken to in an unacceptable way and the commission spoke to the staff member about this. The member of staff has been observed supporting residents at other times very appropriately, and it is considered that it is a lack of appropriate and adequate training that is the cause. The manager has been required for some time to provide a training Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 22 course for staff about understanding and managing challenging behaviours, and a course date has only just been booked. This incident demonstrated how the lack of appropriate training could impact on care, and the manager must ensure that the training is provided as planned, and that she ensures that the lessons learned during the training are put into practice by all staff. The majority of staff are either qualified, or are undertaking an NVQ (National Vocational Qualification) at level 2 or above. The 2 newer staff are undertaking induction linked to LDAF (Learning Disability Award Framework). There have been concerns from the commission in the past regarding the small number of staff available. The planned closure of the sister home, Birchall Avenue, by the proprietor is designed to alleviate some of these staffing problems, as staff will concentrate after that home’s closure on Chatterley House. This visit again showed fluctuating staffing levels since the period from the last unannounced random visit was made in August. At this visit it was found that 2 staff were off on long term sick, although they were both due to return the following week. Also, one of the night staff that had only been employed for a few months had left. The home had again been struggling to provide 2 staff on the 3pm to 10pm shift, and 3 nights a week they had moved back to having a member of staff sleeping in, as opposed to a waking night. The manager said that she had advertised for night staff and was due to interview later in the week. With the return of the 2 staff from sickness absence the home would be up to full staff complement again, and the closure of Birchall Avenue, anticipated to be before Christmas, would also mean that a strengthened staff team would be in place. The commission can accept that the staffing levels will be improved again within a short time. What cannot be accepted in the future is for the staffing levels to fall below 2 staff on duty during the day/evening shifts or a waking night staff being on duty at night, as agreed with the Fire Officer and the commission. Sufficient numbers of staff must be in place to meet the needs of the residents, and this will be even more important once 2 further residents move to the home. The home is required to keep the staffing levels under regular review, and to take action to maintain the staffing levels on each shift if the staff team reduces through staff leaving or through sickness absence. This may mean staff undertaking additional shifts, or the use of agency staff. The commission will monitor the above and action may be taken should the staffing levels not be maintained. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 23 There are no senior care staff employed at Chatterley House. This means that in the absence of the manager there is no-one senior to take responsibility for overseeing care practices, for undertaking supervision of staff, to undertake delegated tasks for the manager or liaising with the commission or other professionals. While the regulations do not make it a requirement for senior care staff to be employed, as good practice the home is recommended to consider introducing this tier of staff, which it is considered would assist the smooth running of the home. The recruitment procedures adopted by the home have fallen short in the past. The files of the 2 newer members of staff were seen at this inspection and it was pleasing to note that all of the required information, including an application form, 2 references, POVA First (Protection of Vulnerable Adults) clearance and later CRB (Criminal Records Bureau) was in place. Staff had a statement of terms and conditions and had received a copy of the General Social Care Council Code of Conduct. Response to the mandatory training of staff has been poor in the past. Through requirements made by the commission this has improved since the last key inspection. New staff now receive an induction based on LDAF (Learning Disability Award Framework) and all mandatory training has been either addressed or there was evidence that courses have been booked. The home must maintain this level of staff training and keep the training needs of staff under regular review. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 24 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. 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. The home has improved since the last inspection, but there still remains a need for a better understanding of the standards and regulations of the Care Standards Act by the manager, and more of her time spent on the management of the home, to ensure that the needs of the residents are at the heart of the service. EVIDENCE: The Registered Manager has been managing the home for a number of years. She has overall responsibility for running the home, which is set out in a job description. The home has a history of showing some improvement following an inspection and then standards fall again somewhat by the next visit. This has been Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 25 discussed with the manager and the proprietor that this could not continue, and at this inspection it has been noted that the improvements seen against the requirements made from the last inspection, which was followed up by monitoring visits, are generally being maintained. The manager must continue however, to maintain the improvements and to address the requirements made at this inspection in a timely way. The manager said that she was continuing to improve her knowledge of the Care Standards Act. There has been a recent issue with the home regarding a lack of proper consideration of the impact of the building work that is being undertaken at the home. The plan is to close the ‘sister home’ of Chatterley House and for the 2 residents from that home to move into the new extension. This will assist with staffing the home. However it was not made clear to the builder that the home had to remain completely open, and the result has been that one of the residents has not had access to his bedroom for 2 weeks. This has been resolved by the resident going on holiday, but the responsible persons should have ensured the continuity of care for all of the residents whilst the work was being done. This is another example of the responsible individuals not properly addressing the residents’ care needs. It was also found at the inspection that a requirement made for the manager to contact the Social Services Department to discuss the situation about the resident being displaced had not been addressed. She advised that she would undertake this the next day. As well as contacting the care management team it would show integrity for the manager to contact the commissioning department of social services and explain the situation to them as well, as they may wish to introduce a financial penalty. Should this action not be taken, the commission may contact the commissioning team to alert them to the situation. It is a further requirement of this report that the registered manager and registered provider manage the care home with sufficient care, competence and skill. The manager advised that the professional relationship between her and the proprietor continued to be maintained. This was an issue at the last inspection but has clearly improved over the recent months as evidenced during the monitoring visits. Because of difficulties in running the home over the past 12 months, there has been little focus on the development of quality assurance systems. The home does however hold regular meetings with service users to ask their views about issues in the home. The views of relatives who returned comment cards to the Commission earlier in the year were positive about the outcomes being achieved for each of their relatives. The Commission requires the home to establish and maintain a system for reviewing the quality of care provided at the home. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 26 The manager’s effectiveness in maintaining safe working practices were sampled in the following areas: At the last inspection the home had not trained staff in safe moving and handling techniques and there were no moving and handling risk assessments in place for individuals. This has now been addressed. The Fire Officer has recently made a return visit to the home and considers that fire safety issues are being managed effectively at the present time. The home maintains appropriate records for fridge, freezer and cooked food temperatures. All COSHH (Control of Substances Hazardous to Health) were stored appropriately in a locked cupboard. There were up to date certificates in place for the safety of gas and electric installations. PAT (Portable Appliance Testing) has been carried out. There were a number of issues around the above areas at the last inspection and it was pleasing to note that these have been addressed. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 27 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 X 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 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 1 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 X 1 X 2 X X 3 X Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 28 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(2)a Requirement The home is required to review the care plans of each resident at least every 6 months, or more frequently if the circumstances and needs of the resident change. Keep details of the specialist communication needs of 1 resident and methods of communication with her that may be appropriate. The home is required to make arrangements to enable all residents to engage in social and community activities of their choice. (This was a previous requirement and has not been fully met) The manager is required to ensure that the home makes proper provision for meeting the heath needs of service users. (In this particular case this is to ensure that the particular resident is weighed regularly and a record kept of her weight on Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 29 Timescale for action 21/01/07 2. YA6 17(1) a and Schedule 3 16(2) m, n 21/01/07 3. YA13 21/12/06 4. YA19 12(1)a 31/12/06 every occasion, with the weight notified to the GP if there is any cause for concern, i.e. weight gain. 5. YA19 13(1)b, 12(1)a, b The manager is required to make 31/12/06 arrangements for residents to receive treatment or advice from any relevant health care professional. (in this particular case this is for the resident that was discussed to be referred to community psychiatric/behavioural nurse specialist). The manager is required to ensure that appropriate recording is maintained in all instances for all medication. (There must be no gaps on MAR charts) Ensure that the training planned for staff about abusive practice and the safeguarding of service users is undertaken by all staff Ensure that the planned training in behaviours that challenge is undertaken by all relevant staff 6. YA20 12(2) 23/11/06 7. YA23 13(6) 31/01/07 8. YA23 13(7) and (8) 13(3) 31/12/06 9. YA30 The manager is required to 31/12/06 introduce appropriate procedures for the handling of soiled laundry. The manager should take 21/01/07 appropriate advice to assure herself that the washing machine has suitable programmes to safely wash soiled linen to control the risk of infection Keep the staffing levels under 21/01/07 regular review and maintain satisfactory staffing arrangements as identified within the report DS0000008209.V320678.R01.S.doc Version 5.2 Page 30 10. YA30 13(3) 11 YA33 18(1)a Chatterley House 12 YA37 10(1)a The registered manager and 28/11/06 registered provider must manage the care home with sufficient care, competence and skill at all times. The Commission requires the 31/01/07 home to establish and maintain a system for reviewing the quality of care provided at the home. 13 YA39 24(1) (2) (3) 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 YA6 YA6 YA23 3. YA33 4. YA33 5 Good Practice Recommendations It is recommended that the information in the care plans be kept in a more orderly way. Continue to research ways to make the care plans more user friendly. The manager should assure herself that staff have understood the training and their obligations about behaviours that challenge and the protection of vulnerable adults Consider introducing a deputy or senior care worker role, which it is considered would assist the smooth running of the home. Contact the commissioning team of Stoke on Trent Social Services Department to explain the circumstances regarding the loss of his bedroom for 1 resident and the period involved. Chatterley House DS0000008209.V320678.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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