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Inspection on 03/05/07 for Chatterley House

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

This inspection was carried out on 3rd May 2007.

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 7 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. Those who were at home at this visit all said that the staff are good to them. 2 residents have moved permanently into the home following the closure of the `sister home` to Chatterley House, and each said that they liked being there. `I like it here. The staff help me to do the things that I want. I am getting out more.` Another person said that the staff laugh and joke with him, which he enjoys. The owner has purchased a large holiday property abroad for the residents` benefit. They are all visiting at some point during the year. Staff make sure that all of the residents have regular health checks with their doctor and attend the dentist, sight tests, hearing tests and chiropody services as their appointments become due. The residents enjoy their food. They plan the menus for the coming week, and make individual choices about what meals that they want. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 6Chatterley House is comfortable and homely and well maintained. There are spacious grounds. A recent frequent visitor to the home said `It`s a happy home` and this sums up the atmosphere on the day of the inspection.

What has improved since the last inspection?

There have been concerns about the running of the home over the recent past. There were some improvements found at the last inspection and this improvement has continued, so that the number of areas requiring attention has reduced. There has previously been a concern that some of the residents were not going to activities that they wanted to, such as to church and Stoke City football match. People are now attending more activities of their choice. The staff team was previously shared between 2 homes and this meant that at times there were insufficient staff to cover Chatterley House properly. Now that all of the staff work only at Chatterley the staffing levels have improved. This means that people who need the support of staff are not only able to go out more, but that there are more activities taking place in the home. At the last inspection it was considered that the home had not responded promptly to the need of a resident who required some greater professional input than the home could provide, to help him manage some of his behaviour. A referral to the Community Psychiatric Nurse has since been made and she is visiting regularly to provide some support. The training of staff has been neglected in the past. This has steadily improved so that the staff all now receive and are up to date on all the compulsory training that they require. There were some issues previously about the way that the home was dealing with soiled laundry, which meant that there was more chance of the spread of infection. This has been put right.

What the care home could do better:

The home has not always paid full attention to reviewing the needs of the residents and making sure that this current needs are accurately recorded in the individual care plan. This has been required, but the home has also been asked to consider looking at care planning in a new way, so that the person is at the heart of all of the decisions made about their future, with a `can do` approach to achieving what they want for themselves. There was an issue about some eye drops and cream for 2 different residents not being stored properly in the medication cabinet, and it was left out on aChatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 7work surface in the staff room with the door open. This was to save staff time. This is not acceptable and the home has been required to store all medication properly. The staff room did not have any paper towels at the sink and all staff were using a domestic cotton towel, which could increase the risk of the spread of infection. The home has been required to provide more hygienic hand drying facilities. The staff would benefit from more effective management. Staff meetings are very infrequent and they do not receive individual supervision that would help them provide a better service to the residents. The manager has been required to put this right and also to consider with the owner other ways that the management of the home might be improved, such as appointing a deputy or senior care worker, and making clear on each shift that is the lead person in charge, in case of an emergency. There has not been a residents meeting for 12 months, or any surveys of residents and their representatives to find out from them how the service could be improved. The manager has been required to address this.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Chatterley House Chatterley Road Tunstall Stoke-on-trent Staffordshire ST6 4PX Lead Inspector Irene Wilkes Unannounced Inspection 3rd May 2007 10:00 Chatterley House DS0000008209.V339298.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.V339298.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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.V339298.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 11 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (11), Mental disorder, excluding of places learning disability or dementia (1) Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2006 Brief Description of the Service: Chatterley House is a care home registered for 11 people. The home can accept people over the age of 18 years and above that have a learning disability. They are registered for 1 place for a resident with a mental disorder that does not include a learning disability or dementia. 9 gentlemen and 2 ladies currently live at the home, in a detached property set in its own grounds. The proprietors house is situated next door. 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 to assist the residents to have access to community facilities. 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 residents use. Tunstall, however, has the range of shops that you would expect of a small town. Chatterley House has recently been extended with the addition of 2 en suite bedrooms, which has enabled the ‘sister home’ of Birchall Avenue which was nearby to close, allowing the 2 residents from there to move to Chatterley House. The home now has the 2 en-suite bedrooms, 5 further single bedrooms that are not en-suite, 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 residents with opportunity for personal development. The charges for the service are £335 per week. Residents purchase their own items, such as personal toiletries, newspapers and magazines. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that was undertaken over a whole day in early May 2007. The core national minimum standards that are recognised by the commission to have most impact on the health, safety and welfare of the residents were all looked at. 7 residents who were at home were spoken with during the visit, and the way that the staff talked to them and assisted them was observed. The residents’ needs were discussed with the 2 staff that were on duty, and 1 of them was more formally interviewed. The owner was at the home and spoke to the inspector during the course of the visit. A visitor who had been attending the home for several weeks also spoke about what her views were about the care in the home. A telephone conversation was held with the manager on the following day, as she was not on duty at the time of the inspection. The main records kept in the home were inspected, including a sample of 3 residents’ files, 3 staff files, medication records, staff rotas and training records and other records relating to the health, safety and welfare of those living in the home. What the service does well: The residents like living at the home. Those who were at home at this visit all said that the staff are good to them. 2 residents have moved permanently into the home following the closure of the ‘sister home’ to Chatterley House, and each said that they liked being there. ‘I like it here. The staff help me to do the things that I want. I am getting out more.’ Another person said that the staff laugh and joke with him, which he enjoys. The owner has purchased a large holiday property abroad for the residents’ benefit. They are all visiting at some point during the year. Staff make sure that all of the residents have regular health checks with their doctor and attend the dentist, sight tests, hearing tests and chiropody services as their appointments become due. The residents enjoy their food. They plan the menus for the coming week, and make individual choices about what meals that they want. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 6 Chatterley House is comfortable and homely and well maintained. There are spacious grounds. A recent frequent visitor to the home said ‘It’s a happy home’ and this sums up the atmosphere on the day of the inspection. What has improved since the last inspection? What they could do better: The home has not always paid full attention to reviewing the needs of the residents and making sure that this current needs are accurately recorded in the individual care plan. This has been required, but the home has also been asked to consider looking at care planning in a new way, so that the person is at the heart of all of the decisions made about their future, with a ‘can do’ approach to achieving what they want for themselves. There was an issue about some eye drops and cream for 2 different residents not being stored properly in the medication cabinet, and it was left out on a Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 7 work surface in the staff room with the door open. This was to save staff time. This is not acceptable and the home has been required to store all medication properly. The staff room did not have any paper towels at the sink and all staff were using a domestic cotton towel, which could increase the risk of the spread of infection. The home has been required to provide more hygienic hand drying facilities. The staff would benefit from more effective management. Staff meetings are very infrequent and they do not receive individual supervision that would help them provide a better service to the residents. The manager has been required to put this right and also to consider with the owner other ways that the management of the home might be improved, such as appointing a deputy or senior care worker, and making clear on each shift that is the lead person in charge, in case of an emergency. There has not been a residents meeting for 12 months, or any surveys of residents and their representatives to find out from them how the service could be improved. The manager has been required to address this. 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.V339298.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 and 3 Quality in this outcome is 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, so that they can feel confident that the home understands the support that they will require. EVIDENCE: The only 2 admissions to the home since the last inspection are 2 residents from what was the ‘sister home’ of Chatterley House, which has now closed. Chatterley House was extended with the addition of 2 en-suite bedrooms to allow this to proceed. The 2 transferring residents have been allocated the new rooms. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 10 The needs of the 2 residents who have transferred were already well known, as 1 staff team covered both homes. As important, the 2 gentlemen previously spent a good deal of their time at Chatterley House also, so they were both excited about the permanent move there. Both residents were spoken to and said that they had settled in well and were pleased that the move had taken place. Their complete records moved with them and they contained information about the transfer process. Previous inspections have shown that all residents’ needs are appropriately assessed before they move into the home. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 (Adults 18-65) and 7, 14, 33 (Older People) Quality in this outcome is is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to make everyday decisions about their lives and are able to make informed choices about taking day-to-day risks. EVIDENCE: 3 care plans were looked at. These provided evidence of how the users of the service are supported by staff. 2 residents said that staff talk to them sometimes about their care plan and it was seen in their files that they had signed that these discussions had taken place. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 12 2 of the 3 files had been updated to reflect the current needs of the residents but 1 file had not been updated for some 12 months. This was for a resident who does not speak but can understand what is said to her. Discussion with 2 staff evidenced that they communicate well with the resident and can interpret her facial expressions and gestures, and that she is becoming more confident and outgoing since going to live at the home. The home should make sure that her written care plan is reviewed as her needs change so that her greater confidence and resulting independence is known about and promoted by all staff, and this is required. It is recommended that a communication sheet be drawn up and added to on an ongoing basis as a greater understanding of the resident’s communication is gained. There were clear records kept of the review meetings held under the Care Programme Approach for 1 resident for whom this was relevant. Residents confirmed that they lead their chosen lifestyle. The majority have lived in the home for some time and they continue to attend day services, one has a relationship with a lady friend and attends sheltered employment, and others are supported to travel independently. There are 4 residents who live in the home who are over 65 years and they too are supported in making individual choices. The home recognises that their choices may be different from those of a younger age living in the home. Whilst the home can evidence that they actively support the residents to continue the set pattern of their lives, the manager has not to date actively pursued person centred planning and the further development of interests and abilities that could be promoted for some of the residents. Previous inspections have highlighted that the plans would benefit from being in a more user-friendly style and in a format that would aid more person centred planning, but this has not yet happened. This remains a recommendation for the home to consider. The manager is the appointee for all of the residents for their state benefits and supports them to manager their finances. Records are kept of all transactions and these records were independently audited some 6 months ago. Residents have always been supported to lead an independent lifestyle but until recently discussions about risk with each individual have not always been written down. This had improved at the last inspection and there was evidence that a review of the risks that presented for each individual about their chosen lifestyle had been undertaken recently in 2 of the 3 files inspected. Residents spoken with explained how the staff talked to them about risks that they may Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 13 encounter when accessing the community independently and discussed what they should do about road safety, strangers talking to them, etc. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 15 Standards 12, 13, 15, 16 and 17 (Adults 18 –65) and 10, 12, 13 and 15 (Older People) Quality in this outcome is is good. This judgement has been made using available evidence including a visit to this service. Now that the staff team only covers Chatterley House the lifestyle needs of all of the residents are better met. Visitors are made welcome in the home and mealtimes are an enjoyable social occasion for residents. EVIDENCE: The majority of the younger residents who have lived at the home for some time are all engaged in meaningful activities. 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 lunch-times. Residents who were spoken with at this inspection confirmed that they remain happy with their lifestyle. 1 was just getting ready to go out to sheltered employment, and another said that he still attends day services that he enjoys, but that he was at home on the day of the visit as he was going to the dentist. 1 resident was out working as a volunteer at the Red Cross charity shop and 2 others were at day services. 1 had gone shopping out to the local town quite early, as his routine. The remaining residents who were at home talked about their plans for the day, which included shopping, going for a drink at lunchtime and sitting in the garden. All of the residents access the local community. They visit the range of facilities available to everyone and access public transport and taxis. The home also has its own mini bus that staff drive, to ensure everyone can make visits to places that they choose. At previous inspections there has been concern that due to restricted staffing levels some of the residents were not being given the opportunities to take part in the activities that they enjoy in the community. This included going to church and to football matches. Since the sister home of Birchall Avenue has closed, the staff team are now based solely at Chatterley House, and this has made a marked difference in the numbers of staff available to support the residents in going out. 1 of the residents talked about going to the football match regularly, and there was evidence in records that those who wish to are now attending church. The difference in the amount of outside activities being enjoyed was marked. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 16 Several residents were excited about going on holiday in a couple of weeks to Turkey. The owner has purchased a large bungalow for them to enjoy and this will be the first visit. 7 residents are going, with the remaining 4 having the opportunity later in the year. The home is very good at supporting the residents to maintain family links and friendships. Residents who have family confirmed that they are supported by the staff to visit the home, and for them to go to their houses when planned. The resident with a lady friend confirmed that she still visits regularly for tea. Another resident said that his sister is made welcome at the home. Records also showed that friends of individuals such as from the church or a previous placement are still invited to the home or welcomed at unplanned visits. 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. 1 resident came into the dining room for breakfast at approximately 9.45am. She had chosen to have breakfast first before showering and dressing. There is evidence in records that residents have been offered a key to their bedroom and front door. 1 resident confirmed that he continues to keep his key and that it is important to him to maintain his independence. Staff were observed to respect the privacy of the residents by knocking on their bedroom doors before entering, and they were overheard interacting with them in a positive way. An NVQ Assessor who has been visiting the home for several weeks said that she was very impressed with the way that the staff interacted with the residents. She said that it was clear from her first visit that ‘it’s a happy home.’ The Assessor also talked about the activities that she has observed both residents and staff taking part in, such as baking, skittles, dominoes and board games. She confirmed that she had noted that residents are encouraged to take part but that individual choices were respected where residents chose to just observe or sit alone. This was also seen at the time of the visit, as was the fact that activities undertaken are age appropriate. It is pleasing to note how much more time the staff have for interacting with residents and not solely attending to cleaning or administrative tasks. Residents confirmed that they continue to enjoy their food. They explained how they all sit down on a Sunday and discuss the menu plans for the coming week. They said that the staff talked to them about food ‘that’s good for me.’ Residents also confirmed that they could make different choices should they change their mind about what is on offer. There was evidence of plenty of fresh vegetables and fruit being available. The menu book was seen and confirmed the range of food available. All of the residents choose to eat in the dining room and it was observed that meals are a social occasion. Some residents confirmed that they assist staff in the kitchen on occasions. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 (Adults 18-65) and 8, 9 and 10 (Older People) Quality in this outcome is is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs, and the principles of respect, dignity and privacy are put into practice. Staff must always, however, adhere to the proper practice around medication that they have been taught in their medication training, to ensure the health and safety of residents is continually maintained. EVIDENCE: Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 18 The 3 care plans inspected had recorded evidence about the preferences of the resident in the way that they are supported. Staff were observed at the visit and they were discreet in prompting residents about attending to their own personal hygiene, and where they provided support this was done in private. The files that were inspected showed that the residents get up in a morning dependent on their schedule for the day. 1 resident who was still in bed at the start of the inspection was seen to get up at her own choosing. The files sampled showed that residents usually go to bed between 10.30-11pm. When asked 2 people confirmed that they please themselves about what time they go to bed, and there is no pressure. The home has a history of ensuring that the healthcare needs of the residents are met and this has continued. All residents are supported in gaining access to their GP and other healthcare professionals and there were full records kept in the 3 files sampled of all visits and their outcomes. A resident was attending his 6 monthly dental check up on the day of the visit. There was evidence that a CPN (Community Psychiatric Nurse) was involved in the care of a resident and that the staff were completing a behavioural chart at his/her request. There were good records of Care Programme Approach meetings, and that all appointments with the psychiatrist had been kept and advice followed. The care plans that were inspected did not show any evidence that the residents had given their consent to the care workers giving them their medication although it is clear that they are able to make their own choices when their medication is provided. It is recommended that the home gain the written consent of each resident to the administration of medication, to provide a clear audit trail. There were clear records available of the medication received, administered and leaving the home. A current MAR (Medication Administration Chart) was available for each resident and had been completed in full in each case. The home has an appropriate locked medication cabinet that is fixed to the wall in the office. There are no Controlled Drugs being used currently. The Monitored Dosage System is used. Staff stated that there were no drugs to be administered during the visit. However, when the medication cupboard and MAR charts were examined it was found that a cream to be administered for 1 resident and eye drops for another had been left in the staff room on a worktop, additionally with the door to the staff room open. Staff said that these medicines were sometimes left out to save time, as they had to be administered several times throughout the day. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 19 Staff were advised that this is not acceptable and were instructed to store the medication appropriately with immediate effect, which was done. It is a requirement that all medication is stored securely. There was evidence available to show that all staff that administer medication have received training, and where relevant, refresher training from an external source. The manager confirmed that this training was appropriate to the tasks that they perform. The manager is recommended to continually monitor the compliance of staff against the medication policies and procedures for the home. The issue identified above suggests that not all aspects of the medication training has been embedded in their practice. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 (Adults 18-65), 16, 17, 18 and 35 (Older People) Quality in this outcome is is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, have access to an effective complaints procedure and are protected from abuse. 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 complies with the standards in terms of timescales etc. and it also contains information that the Commission can be contacted at any time about a complaint. The procedure would benefit from availability in other formats, such as large print, pictorial, audio etc. to help those living in the home to make a complaint should they wish to, or to make suggestions for improvement, and this is recommended. All of the residents spoken with said that they are happy in the home and said that they knew that they could complain about anything they did not like. They Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 21 said that the staff and the manager always listen to anything that they have to say. No formal complaints had been made to the home. The commission has not received any complaints about the home. The home now maintains a minor grumbles/ incident book and 2 issues of grumbles between residents were recorded. These showed appropriate investigation and outcomes. The home has a previous poor history of training staff about the understanding of safeguarding adults. This has now been addressed including all staff having received safeguarding adults training and additional training in the understanding of challenging behaviours. The home now has the Department of Health publication entitled ‘No Secrets’ and additionally the Staffordshire multi agency procedures for the Protection of Vulnerable Adults available for staff to read. A member of staff was interviewed and an abusive practice scenario was put to her. She had a good understanding of the various forms that abuse could take, and about her reporting responsibilities. The manager is recommended to periodically test out that staff have read and understand their responsibilities. The home’s policies and practices regarding residents’ money and financial affairs were tested out via a random sample of personal financial records and the storage of users’ monies. Money and records were securely stored, and the running balance for the 2 records sampled tallied with the money available for each person. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 (Adults 18-65) and 19 and 26 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, that encourages independence. The manager must be more proactive, however, in ensuring that there are adequate procedures in place for the control of infection, rather than waiting for issues to be raised by the Commission before good practice is introduced. EVIDENCE: Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 23 Chatterley House provides spacious accommodation for 11 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, wellequipped kitchen and sufficient bathrooms. Since the last inspection 2 additional single bedrooms with en suite facilities have been provided to enable the sister home of Chatterley House to close, with the 2 residents now having moved successfully into Chatterley. The residents confirmed that they are happy with their bedrooms and the wider environment of their home. The Fire Officer made a number of visits during the last year regarding the improvements required to ensure that the home complied with the new fire regulations that came into force in October 2006. The home responded in a timely way to ensure that both the physical improvements needed and the risk assessments and staff training were addressed. At his last visit in November 2006 the Fire Officer confirmed that he was satisfied with the fire safety within the home. The manager is not proactive in addressing good practice requirements in infection control. It has been through requirements made during inspection in the past that good practice has been introduced. At this visit the home was very clean and well maintained, but it was noted that paper towels were not available in the staff room, rather a domestic cotton towel was in place. It is a requirement of this report that disposable towels are available at the sink in the staff room. During the last visit it became apparent that the home was not following appropriate laundry procedures for washing soiled linen and the manager was required to improve practice. This has been addressed and there was adequate and appropriate equipment, protective clothing and suitable water-soluble laundry bags being used to minimise the spread of infection. The manager also confirmed that the washing machine is appropriate for the washing of soiled laundry at appropriate temperatures. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34, 35 and 36 (Adults 16-25) and 27, 28, 29 and 30 (Older People) Quality in this outcome is is adequate. This judgement has been made using available evidence including a visit to this service. Staff in the home are well trained and in sufficient numbers to support the people who use the service. Residents and staff would benefit, however, from being more effectively managed and supervised. EVIDENCE: There have been concerns from the commission in the past regarding the small number of staff available. The sister home, Birchall Avenue, has now closed, Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 25 and this means that the staff team of 7 plus the manager are concentrated on the one home, to meet the needs of 11 residents. The staff complement now allows for 2 staff on duty during the day and evening, and 1 waking night, with each staff member covering 1 night shift each week. These staffing levels have been discussed previously with the home as the minimum acceptable, and are considered satisfactory at the present time to meet the current needs of the residents, but must be kept under regular review. At this visit the staff showed much greater involvement with the residents who were at home, and the atmosphere was much more relaxed. The staff on duty confirmed that the current staffing arrangements have considerably improved their ability to spend time with the residents. 2 staff were questioned about the needs of some of the residents and they had a good understanding of their individual needs. The interaction of staff with the residents was discreetly observed and they related well to each individual. An NVQ Assessor who was visiting the home said that she had always noted that staff respected the residents and appeared motivated and committed. There is 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 etc. It is recommended that a deputy manager or senior care worker be employed. Additionally it is recommended that on each shift there is someone nominated to take the lead should an emergency arise. The recruitment procedures adopted by the home have fallen short in the past. The files of 3 members of staff were seen at this inspection and the majority of the requisite information was in place, except that there was no proof of identity in 2 of the 3 files, including no photograph of the staff member. It is a requirement that this is addressed. Response to the mandatory training of staff has been poor in the past. Through requirements made by the commission this has improved over time. The inspection of 3 staff files showed that for more recently employed staff they have received LDAF (Learning Disability Award framework) training as part of their induction training. This is supplemented by induction about the needs of older people. Staff have received all mandatory training. Training about responding to behaviours that challenge has been undertaken since the last inspection. Staff have received training in infection control, food hygiene, moving and handling, medication, safeguarding adults and optical awareness. Staff still require training about equality and diversity and this is recommended. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 26 71 of staff has an NVQ (National Vocational Qualification) at Level 2 or above. There were no recent supervision records found in the staff files, and discussion with the 2 staff on duty evidenced that staff are not receiving supervision on a regular basis. Records showed that 12 months had elapsed since some staff had received supervision. There was no record of any annual appraisal in the staff files seen. Staff on duty confirmed that they had not had an appraisal, and the manager later confirmed in a telephone conversation that she had not undertaken these. There was evidence of a staff meeting being held in April last year, and then only in February 2007. The staff said that they had not had a meeting for some time. It is a requirement of this report that all staff receive appropriate supervision. It is a recommendation that the supervision of staff includes an annual appraisal. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 (Adults 18-65) and 31, 33, 35 and 38 (Older People) Quality in this outcome is is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is improving although more effective leadership and attention to quality assurance are still required. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 28 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 manager reported that she has been attending various meetings and some courses to maintain and update her knowledge base for managing the home. The manager works towards meeting the individual needs of the residents. A vibrating sensor linked to the fire system has been purchased for a resident who has hearing difficulties, and referrals have been made to other professionals to support individual needs, such as the involvement of the Community Psychiatric Nurse to assist with the understanding and management of some limited behaviours that challenge. Residents are now being supported to develop their interests and activities, such as to attend church and football matches. All the residents are being supported in age appropriate activities in their leisure time within the home. Residents are confident that they are listened to. However, the manager needs to be more forward thinking in developing the service further by giving a clear sense of direction, and understanding the importance of quality assurance and the need to promote and support residents to be involved in the running of the home. The home has a history of showing some improvement following an inspection and then standards fall again somewhat by the next visit. It was noted at this visit however that the improvements made at the last 2 inspections have generally been maintained and in some instances further developed. There were concerns throughout the last year about poor relationships between the owner and the manager that was impacting on residents and staff. Both report that the issues have been resolved. The staff on duty were asked about the current situation and said that relationships have greatly improved. Quality assurance systems need improvement. There has not been a residents’ meeting for 12 months. Neither have residents or relatives been surveyed regarding their views of the home, although the manager says that she has developed a questionnaire ready for distribution. This has been the answer for consecutive inspections but allowances have previously been made due to the difficulties that were being experienced in the home. The manager is required to review the quality of care provided at the home, including a formal consultation with residents and their representatives, and to produce a report detailing what action is to be taken on the outcome of the review, and to provide a copy to the commission. Safe working practices were sampled in the following areas: Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 29 All fire records including fire drills, training of staff, testing of equipment were up to date. There were fire risk assessment in place for individual residents and the whole building. Staff are trained in first aid. 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. The need for a better understanding of infection control and practice of measures to prevent spread of infection has been highlighted elsewhere. There was evidence that a number of risk assessments had been written for safe working practices within the home but these have not been reviewed since January 2002. A recommendation is made to check that these risk assessments are still relevant. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 30 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME 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 3 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 3 34 2 35 3 36 1 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 1 40 X 41 X 42 3 43 X 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Chatterley House Score 3 3 2 X DS0000008209.V339298.R01.S.doc Version 5.2 Page 31 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)b Requirement The home must review the care plans of each resident at least every 6 months, or more frequently if the circumstances and needs of the resident change, to make sure that all care staff are aware of each persons’ current needs and how they wish to be supported. (This was a previous requirement that has not been fully met) All medication in the home must be securely stored, which includes creams and eye drops, to make sure that residents do not have access to medication that is not prescribed for them. Disposable towels must be available at the sink in the staff room, to reduce the possibility of the spread of infection. Ensure that proof of identity, including a photograph is obtained for all care staff before they commence employment, DS0000008209.V339298.R01.S.doc Timescale for action 31/07/07 2. YA20 13.(2) 04/05/07 3. YA30 13(3) 04/06/07 4. YA34 19(1) b and Schedule 2 04/05/07 Chatterley House Version 5.2 Page 32 and that this is kept in their individual file. 5. YA36 18(2) Staff must receive appropriate supervision from the manager. This is to ensure that they are being supported in their roles to support the residents. Review the quality of care provided at the home, including a formal consultation with residents and their representatives, produce a report detailing what action is to be taken on the outcome of the review, and provide a copy to the commission. 04/06/07 6. YA39 24 31/07/07 7. YA39 24(1) (2) (3) The Commission requires the 31/07/07 home to establish and maintain a system for reviewing the quality of care provided at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations It is recommended that a communication sheet be drawn up for the resident who does not communicate verbally, and added to on an ongoing basis as a greater understanding of the resident’s communication is gained. Research ways to make the care plans more user friendly and person centred. This means that individual plans are developed with the person to reflect what is important to them, so that actions taken are about life, not just services, and reflect what can be possible, not just what is available. DS0000008209.V339298.R01.S.doc Version 5.2 Page 33 2. YA6 Chatterley House 3. YA20 4 YA20 It is recommended that the home gain the written consent of each resident to the administration of medication. Whilst the home has administered medication for all of the residents for some time now there is no formal record that they agree to this. Such a record would provide clear confirmation and an audit trail. The manager is recommended to continually monitor the compliance of staff against the medication policies and procedures for the home. This is to ensure that the medication training that they have received is put into practice. Consider providing the complaints procedure in other formats, such as large print, pictorial, audio etc. to help those living in the home to make a complaint should they wish to. The manager is recommended to periodically test out that staff understand their responsibilities regarding safeguarding adults. This includes discussion about whistle blowing. Consider introducing a deputy or senior care worker role, which it is considered would better ensure effective management of the home in the manager’s off duty time. Nominate a member of staff on each shift to take the lead should an emergency arise. This would better ensure the health and safety of the residents with staff being clear about their responsibilities Provide training to staff to give them a greater understanding about promoting equality and valuing people’s differences. (Equality and diversity training). Provide all staff with an annual appraisal of their work, which gives both the manager and staff the opportunity to think about their practice and the training needed for their further development. Review the risk assessments for safe working practices within the home to ensure that they are still relevant. This is because they have not been reviewed since January 2002 and may now be out of date. 5 YA22 6 YA23 7. YA33 8. YA33 9 10 YA35 YA36 YA42 11 Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Stafford Local 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. Extracts may not be used or reproduced without the express permission of CSCI. Chatterley House DS0000008209.V339298.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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