Inspection on 09/02/06 for Chatterley House

This inspection was carried out on 9th February 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 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chatterley House 12/02/09

Chatterley House 03/05/07

Chatterley House 21/11/06

Chatterley House 02/05/06

Chatterley House 24/05/05

Chatterley House 14/12/04

Chatterley House 02/08/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Chatterley House Chatterley Road Tunstall Stoke-on-trent Staffordshire ST6 6PX Lead Inspector Irene Wilkes Unannounced Inspection 9 February 2006 09:30 th Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chatterley House Address Chatterley Road Tunstall Stoke-on-trent Staffordshire ST6 6PX 01782 834354 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Alice Clarke Ms Teresa Sloan Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2005 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, and this allows good access and daily contact with the care manager and the service users. The home is situated just outside Tunstall, which is one of the towns that make up the City of Stoke-onTrent. 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 a range of holidays of their choice. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a part day in February 2006. The manager was not on duty on the day, but visited the home for a short period when she was made aware that an inspection was taking place. This was appreciated. There were five out of the nine service users at home, and two of these were relatively new residents. The inspector spoke to all of them. One person has no speech but appeared to understand what was said to her. Two staff were on duty on each shift of the day. One of the staff on the morning shift was seen in private when her understanding of the needs of the service users and other details about the home was briefly checked out. What the service does well: People are happy living at Chatterley House. ‘I please myself when I go to bed, when I feel like it’. ‘The food’s all right. If I don’t want something I can choose something else.’ Most of the people living there lead busy lives, either attending a day service, or working, in one case in paid employment and in another as a volunteer. The home has a full size pool table and people enjoy their evenings playing pool in the large and pleasant conservatory. The one lady who does not speak nodded her head and smiled when asked if she liked the home. Attention is paid to the health needs of the service users. Each attends a well woman or well man clinic and the residents are supported to attend other health appointments with the GP, chiropody, dental and any other physical or mental health specialists. There are safe systems in place for medication, and two of the service users look after their own medication, supported by the staff. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 6 People feel that the staff listen to them and say that they sit with them on their own to talk about any issues. Minor grumbles are soon dealt with so that these don’t grow into bigger problems. Chatterley House provides a lovely environment. It is spacious but with a homely feel. The home has a committed staff team and it was clear that the staff and service users get on well together. The home makes sure that staff undertake the national training award for care (NVQ). What has improved since the last inspection? What they could do better: The care plans in place for each service user should show that the home is working in a planned way with each person towards them meeting their goals and wishes for the future. This doesn’t happen for everyone. The home has only a small team of staff who also cover another home close by where two service users live. If any of the staff are on holiday or off sick it becomes very difficult to cover the home with the numbers of staff available. This means that some people are not able to do the activities that they would like, as there is not the number of staff available to support them. While good attention is paid to staff undertaking their NVQ’s, other staff training, such as in medication, recognition of abusive practice, moving and handling, that they all require has fallen behind. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 7 Because of the small number of staff, the manager spends a lot of time covering the rota. More of this time needs to be spent on paperwork, so that all of the records that the home has to keep can be found up to date. The home has been required to address all of these issues, and have been given a set time in which to do so. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 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.V278939.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 The home follows good practice regarding trial visits and the initial assessment of needs of new service users, but is not as good at providing information to the service users via the Service User Guide, or in ensuring that complete records are kept. Because of this the service users and their significant others do not get as full information as they could to make an informed choice about the home. EVIDENCE: A requirement had been made at several previous inspections that stipulated that the Statement of Purpose and Service User Guide had to be improved to contain current information about the home. At the last inspection documents were seen that led the inspector to believe that this had been addressed. At this visit, when examining the files of two new service users it became apparent that the manager had reverted to the old copy of the guide that was not acceptable, as this was rather a ‘pen picture’ of the individual service user. One of the long-standing residents was asked if he had a copy of the guide and it was clear that he was unaware about this. The home is required to develop a Service User Guide to contain all of the information as set out in Standard 1 and regulations 5 and 6 of the national minimum standards and associated regulations, and to provide a copy of the guide to every service user. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 10 The home is further required to provide to the Commission a copy of the Statement of Purpose that is in line with Standard 1 and Schedule 1 of the standards, and that meets the requirements of regulation 4 of the same documents. This information has been required for some considerable time now, and it is expected that the requirement will be met strictly to the timescale allowed. Two new service users had been admitted to the home since the last inspection and both of their files were inspected. They had both previously lived together for many years in a home that had recently closed down. Both of the individual files seen showed that the manager had obtained a summary of the community care assessment from the local authority and a copy of the care plan. There was also an initial needs assessment document in place for each resident that covered all of the requirements of standard 2. The service user plan for the new placement at Chatterley House had been drawn up from these documents. There was no documentation seen in the files of the two service users highlighted above that they had made any visits to the home prior to moving in. However, the inspector is aware that this was the case as at the last inspection this was discussed, and the service users already living at the home had talked about how they had helped to show them around and find things. Also at an additional visit some weeks later the two people were visiting, accompanied by staff members from what was then their present home. Discussion at that time evidenced that a number of trial visits had been made, including an overnight stay. The home is reminded that records about any aspect of care or the running of the home must be maintained, in order to provide an audit trail. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 There are individual plans in place for each service user, and some good responses to looking at the risks that they may encounter in their chosen lifestyle, and how these risks can be minimised. However, greater thought is needed to identify all of the risks that may be present for each service user, which should be discussed with them and recorded. This will provide greater reassurance that whilst promoting an independent lifestyle, the home also addresses its responsibilities to keep people as safe as possible. EVIDENCE: Over a number of visits to Chatterley House, there has been opportunity to talk to the seven long standing residents and to read their care plans to see if they were appropriate to meet the needs of each person. Discussion this time with three of these same service users evidenced that they still are aware of their care plans and contribute to them by discussing with the staff about their lives and agreeing the plans at review. One of the care plans of these long standing residents was looked at again at this inspection. His care plan contained basic information about his needs and lifestyle, there were some satisfactory risk assessments in place, but there was a lack of focus on Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 12 personal goals and aspirations. There was no evidence that a six monthly review had taken place. However, the main focus at this visit was on looking at the care plans of the two newer residents. These had been completed fully showing how the needs of each person, identified from the initial assessment, would be met. There was evidence that the lifestyle of each person, what they had been doing, any issues etc. had been looked at on a weekly basis, but there was no evidence of a formal review at six months for either service user. In response to a requirement for an annual review and development plan for the service overall, the manager had misunderstood and had responded that individual reviews had been undertaken. Within this she had referred to the individual reviews of each new service user in which she said that ‘I feel that we do meet their needs and hopefully cover all their wishes in what they would like to do.’ Evidence at standards 12 and 13 clearly show this not to be the case. It is a requirement of this report that the individual plan for each new service user, and others where they do not attend day services or other activities, is reviewed on a six monthly basis, involving significant others as agreed with the service user, and that it is updated to reflect changing needs that are recorded and actioned. The weekly summary of what has happened during the previous week is not an acceptable substitute for the six monthly review, as this needs to focus on goals, aspirations and outcomes. Whilst it is considered that one of the new service users has an understanding of what is said to her she has no speech. This was shown in the individual plan and staff on duty appeared to understand her facial gestures, body language etc. It is recommended that a record of communication is developed, showing an interpretation of gestures and what staff think they mean, so that more extended knowledge is built up over time of understanding of the person’s communication. There was evidence in each of the three files seen that some attention had been paid to the risks that present for each service user associated with their lifestyle, and accompanying evidence to show the actions to be taken to minimise the risk for each service user. Some of these were good. However, as has been discussed previously with the home, there is not sufficient thought given to the range of risks that might present for each individual. For example, one of the assessments of a new service user identified that the person had no road sense, but there was no risk assessment for this, another assessment talked about inappropriate staring at the opposite sex, but this had not been risk assessed either. Risks presenting in the environment, e.g. unguarded radiators had not been considered for these two service users. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 13 The home is required to undertake a review of the risk assessments in place for all of the residents to ensure that action is taken to minimise any identified risks and hazards that may present for each service user. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 16 The lifestyle for the service users varies according to their capabilities, and where people require a greater support from staff their chosen lifestyle is considered to be compromised. The home must address these issues so that all of the service users are able to undertake the activities that they wish. EVIDENCE: All of the above core standards were looked at during the last inspection. They were all met at that time. The three standards considered this time were in relation to the two new service users. The long-standing service users at the home have each maintained their interests and educational attendances over a long period. It was found at this inspection that for the new service user for whom it was identified, weekly attendance at an elderly needs group had been maintained, both new residents had been on holiday, and they had both attended the weekly social meeting of a number of people with learning disabilities that the majority of the residents at Chatterley House attend. It was disappointing to find, however, that the Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 15 range of activities identified for each person in their initial assessment was not being provided. Both of the care plans showed that for each person a daily outing was necessary. Examination of records over 39 days since the start of the year to the date of the inspection showed that other than the weekly meetings identified above, each person had only been out on two occasions each. Previous activities that were enjoyed variously included going to watch Stoke City, going out for meals, to the theatre, cinema and walking, and none of these had taken place. The service user told the inspector that he wanted to go to the football and a member of staff also said that he kept asking to go. The other service user does not speak, but there were records to show that during the warmer months she wanted to be outside all of the time, a good indication that she wanted to be out of the house, and during the winter months there had been one occasion where she had ‘trashed’ her room. This could be concluded as an act of frustration, as there was no history of this in the recent past. The inspector is very concerned that the needs of the two residents are not being met. It is a requirement of this report that the level of activities is increased for the two newer service users, and it is strongly recommended that the home discuss with all of the service users if they wish to eat out, go to the pub etc. on a more regular basis. It is recommended that the home makes available a notice board to show details of local amenities, advocacy services, complaints procedure etc. It is considered that the current activities enjoyed by people living at Chatterley are those that do not incur a cost or staffing implication. The home should be run to meet the needs of the service users, and not to fit in with the staffing rotas of the home. The daily routines of the home promote the independence and choice of the service users. There was a very relaxed atmosphere and residents confirmed that they ‘do their own thing.’ During the inspection the five service users who were at home were seen to do this, within the limits of their individual plans. Discussion evidenced that they rise and retire as they wish to their own timescale. There was no evidence in the files of the new service users that they had been offered a key to their bedrooms or the front door. This has been a requirement in the past for the long-standing service users, and does not appear to have been carried through again. This is a requirement of this report, and after discussion, if the service user does not require a key this should be recorded in their care plan. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 16 There is no Service User Guide to indicate the service users’ responsibilities for housekeeping tasks, and it was not directly mentioned in their care plans, other than a statement about daily living skills. These issues, along with agreements regarding smoking, alcohol and drugs need to be clearly set out. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The home is mindful of the healthcare needs of the service users and responds well to ensuring that these needs are met. Service users preferences regarding moving and handling need recording. Medication procedures appear safe, but the home needs to provide medication training for staff, and this is made a requirement of this report. Attention to these omissions will ensure that the service users health and safety are further protected. EVIDENCE: The majority of the service users currently living at Chatterley House are independent in personal care and just require prompting to undertake their own personal care tasks. Two people confirmed that they had the support that they need and staff are always available if they want them for advice or to assist on occasions. One service user is doubly incontinent and requires some personal support. Although both of the two new service users are fully mobile, there was no moving and handling risk assessment in place. A formal assessment is needed for both service users, and if no support at all is required from staff this should be recorded in the care plan. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 18 The home is good at responding to the healthcare needs of the service users. The care plans inspected showed appropriate recording of all health appointments, health checks, issues and outcomes for each service user. Well man/well woman health check appointments are kept, and appropriate referrals to other health professionals take place as required. Two of the service users self medicate. There is an appropriate medication procedure in place, and a risk assessment was seen in the file inspected of one of these service users. The procedure followed has been discussed in the past with staff, and the service user concerned said that this was still the same. There was no evidence that this has been reviewed at six monthly intervals, and the home is reminded to look at this when considering a review of all risk assessments as identified at Standard 9 above. The service users who self medicate have a lockable storage facility for this in their bedrooms. The storage of other medication is in a locked cabinet in the office, which is also locked when the manager and staff are elsewhere in the home. These arrangements are satisfactory. Medication is received from the pharmacy in individual dosette boxes. There are no controlled drugs used currently. There is a document available in the medication file that has been signed by the G.P. for the administration of all ‘as and when required’ medication for each service user. The home does not use homely remedies. All records for the receipt, administration and return of surplus medication were appropriate. Medication training has been provided in the past, but only two of the current staff have received this external training. It is a requirement of this report that all staff handling medication receive such training, to the level identified in Standard 20. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The staff team require suitable training regarding the appropriate responses to physical and verbal aggression by a service user before this standard is fully met. Until then service users cannot be confident that their needs are understood, and staff are not appropriately supported by the home’s management. EVIDENCE: The home has appropriate policies and procedures in place for responding to suspicion or evidence of abuse or neglect. A staff member was asked about her understanding of what constitutes abusive practice and what she must do if she encountered this, and she responded satisfactorily. She also reported that she was undertaking this module currently via her NVQ 2. There has been concern in the past that the staff are not sufficiently trained to understand and deal with physical and verbal aggression by a service user. This became less pressing at the last inspection visit, as the two service users for whom this understanding was needed are no longer resident. It was considered at this inspection that this training is once more required to appropriately meet the needs of all of the service users. The manager, who was off duty at the time of the visit nevertheless called into the home and advised that notification regarding a short half day course entitled ‘Dealing with Challenging Behaviours’ had been received, and that she planned to send four staff to this course. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 20 Whilst this is a start, this training is required for all staff, and the manager must make a concerted effort to find another course to ensure that all of the staff receive this training. The manager is recommended to consider the content of the course once it has been completed to assess the comprehensiveness and relevance to meet the needs of the service users at the home. Any shortfalls will need to be addressed in further training for staff. Policies and practices relating to service users monies have been discussed in the recent past and were considered appropriate. The same practices are still in operation. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Chatterley House provides a safe and homely environment for the service users where every effort is made to meet their needs for a comfortable and pleasant home. The home is very clean, but information is required about the laundry, including equipment, and the policies and procedures followed to prevent the spread of infection. It was pleasing, however, that staff have received training in infection control, thus taking steps that the service users exposure to the spread of infection is minimised. EVIDENCE: Chatterley House is a very pleasant home. It provides spacious and safe accommodation for nine service users in a domestic style with comfortable furniture and fittings and good décor in a very homely environment. There is a spacious lounge, separate dining room with a large conservatory off, well equipped kitchen and laundry and sufficient bathrooms for nine service users, with five single and two double bedrooms that are well furnished. The grounds are spacious and well cared for, and there is a summerhouse also in the grounds that the residents can use as an alternative sitting area if they so choose. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 22 The large conservatory has been upgraded over the years with a new floor and furniture. The service users have access to a pool table and a large table football game and these provide at home entertainment that is very popular. Daily records showed that people enjoyed playing pool on most evenings, and a service user confirmed that he enjoyed this. Another service user said that he enjoyed watching the others. The manager is reminded to check with the new service users whether they require any additional furniture and fittings for their bedrooms to meet the standards, and to record in their individual plan if this is not needed. The signed agreement was recorded for the previous service users that they were happy with what was in place, but has not been addressed for the two new people. This is a requirement of this report. The proprietor has in the past taken comments on board whenever issues relating to the environment have been raised, and this has included upgrading of bathrooms and bedroom furniture, and the provision of liquid soap and paper towels and dispenser for hand washing to help prevent cross infection. A tour was made of the communal areas of the home and a number of bedrooms. Everywhere was very clean. The laundry was not given a full inspection at this visit, and the home is required to advise the Commission, in writing, as to how it complies with Standard 30 in the light that one service user is doubly incontinent. It was pleasing to note that three staff have received training in infection control. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 35 The staffing hours available require review so that the appropriate staffing levels can be identified. The current levels, although appearing sufficient to keep people safe do not allow for additional activities outside the home to be provided in line with individual care plans. There are shortfalls in the mandatory training provided to staff. These issues must be addressed to further ensure the health, safety and welfare of all of the service users. EVIDENCE: Standards 32 and 34 were considered at the last inspection. There have been concerns in the past regarding the small number of staff available. This is compounded by the fact that the staff team also cover another home for two service users that is close by. These service users spend part of their week at Chatterley House because of the staffing issues. At this visit it was pleasing to find that two members of staff were on duty. The last inspection visit had found only one member of staff available, and a further additional visit undertaken in November 2005 to find out the progress against the requirements that had been made had also found only one member of staff available. The manager had been required to evidence that a risk assessment had been undertaken to determine the safety of only one member Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 24 of staff being available whenever this occurs, and the manager has informed the Commission that this has been completed. There were five people at home at this visit. The three long standing service users who were at home are able to operate to a high level of independence, and so this would have been an ideal occasion for the two new service users to undertake an activity either within or outside of the home, but no staff supported activities were observed throughout the visit. As it was a nice day, a walk at least could have been undertaken, as this is an activity that one of the service users enjoys. At the last inspection and requested again at the additional visit, the inspector had required a copy of the staff rotas for three months. The manager had responded by supplying one month’s rota, and said that she did not save details about past rotas that had been worked, and that they had constantly had to be changed anyway due to staff sickness and holidays. The lack of these records being available is clearly a breach of requirements that the manager should have been aware of. It is a requirement of this report that the home retains on file a copy of the duty rosters for all care staff, and a record of whether the roster was actually worked. This is set out, along with other records that must be kept in the care home, in Schedule 4. The manager advised that there is currently six staff employed, with one vacancy. This is to provide cover both at Chatterley House and Birchall Avenue, the ‘sister’ home where two people are resident. The duty rotas for February were seen at this visit and showed that there was generally two staff planned for each shift with one ‘sleep in’ staff. The small team of staff means that for any period of sickness absence, holidays or staff vacancies the home has difficulties in ensuring that there is adequate staff cover. The planned rotas, as stated by the manager herself, become meaningless as soon as any sickness etc. occurs, and results in immediate problems for covering the rotas. This has happened in the past, and the manager agreed that there have been recent difficulties again in maintaining staff cover. There has also been quite a turnover of staff, which may be linked, among other things, to the unpredictability of hours that staff are required to work, although some flexibility would naturally always be expected. While two people on the rota may be generally adequate for the day to day running of the home when people are out at the training centre, etc. the home is reminded that the standard requires sufficient staff to be available not just for this but to allow uninterrupted time with individuals both within and outside the home. The lack of activities in place for the two new service users provides evidence that sufficient staff are not available. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 25 The manager is required to undertake a review of staffing levels, linked to each service users’ needs, with particular attention to the comments made earlier in this report at Standard 12 and 13, and to provide a copy to the Commission. It is expected that this review will be undertaken within one month of the receipt of this report and a written copy sent to the Commission within one week later. The outcome of this review will be discussed with the provider as the basis for discussions on the way forward. At the previous inspection, and again at the last additional visit, the home had been required to update the training records to include dates, so that it was possible to determine if mandatory training was up to date for all staff. This had been done in part, but not to the level required. Discussion evidenced that all staff had completed induction training, although as records were not seen it is unclear if this is to the Skills for Care organisation required level, three staff have NVQ 2, two are in progress of completing this. One person has NVQ 3 and one is in the process of completing this. The level of staff training towards NVQ’s is pleasing to note. Regarding other mandatory training, three people have at some point undertaken food hygiene training, but there were no dates or certificates in place to show this and to determine when refresher training was needed. Not all staff, and in some instances no staff, had received health and safety training, medication training, moving and handling, abuse training, training in behaviours that challenge, annual fire safety (although regular fire drills had been held). The last inspection and the additional visit had required a plan of training needs. The manager had responded that this would be provided, but this has still not been received. It is a requirement of this report that all staff must receive training in all mandatory training, including refresher training where the time since the last training took place has expired best practice, i.e. moving and handling training must be repeated annually, food hygiene every three years and so on. The Commission requires information, in writing, showing dates for courses booked (it is appreciated that these may only actually happen some time in the future due to demand, but nevertheless the requirement is for evidence to be seen that places on the relevant courses have been booked). Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 There is an experienced manager in place but it is considered that insufficient time is made available for managerial duties to be addressed, which results in unsatisfactory compliance with the standards in a number of areas, which impacts on the running of the home. EVIDENCE: The Registered Manager has been managing the home for some considerable time now and she has also gained her NVQ4 and Registered Managers Award. She has overall responsibility for running the home, which is set out in a job description. It has been discussed with the manager in the past that whilst being available to cover the rota and to take part in the provision of care is important, more time was required to fulfil the other managerial duties that are required in running the home, such as record keeping, development of policy, ensuring staff training etc. Whilst following discussion between the proprietor and the Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 27 manager this has happened sporadically, the evidence suggests that because of staff shortages this has again fallen by the wayside. The review of staffing levels will be important in determining the number of management hours to be made available. Service users spoken to both before and at this inspection have said that the home consults them about life in the home on a general basis, such as meals, holidays etc. There are occasional house meetings but the manager has in the past said that the service users prefer 1:1 consultation about issues, and the service users again confirmed this. Whilst the home has previously sent out an occasional satisfaction questionnaire about aspects of the home to relatives, this has not yet been undertaken with service users. The home has neither undertaken any self monitoring of where they are at in terms of review of their services and development of the home, and a way must be found to do this and to also involve service users in the process. The manager is advised to study Standard 39 to inform herself of what is required. A sample of maintenance and other records relating to health and safety issues were seen. There was a current gas safety certificate, testing of fire extinguishers was up to date, the insurance certificate for employers liability insurance was up to date, and the fire alarm system had been timely tested. Control of Substances Hazardous to Health (COSHH) materials was generally suitably stored in a locked cupboard and each substance had a relevant data sheet in place. The home is reminded that soap powder is also a COSHH product and this too must be securely stored. There was good record keeping in relation to all aspects of fire safety. There were no moving and handling risk assessments in evidence and no staff training in moving and handling. The home’s attention is drawn to the requirements of section 37 requiring the Commission to be informed of any death, outbreak of infection or serious injury to a service user among other notifications. Issues regarding staffing that could impact on the health, safety and welfare of the service users have been addressed elsewhere in the report. Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 28 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 1 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 X 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA1 YA1 Regulation 4 5 Requirement Provide the Commission with a copy of the Statement of Purpose of the home Provide a Service User Guide that contains all of the information as outlined in Standard 1 and Regulation 5 to all of the service users and to the Commission (This is a previous requirement that has not been addressed) Address the individual aspirations of each service user and ensure that these are recorded in their care plan. Ensure that the plan is reviewed on at least a 6 monthly basis (This was a previous requirement and has not been addressed for ALL service users) Ensure that appropriate risk assessments are in place for all areas of risk for each service user Ensure that service users receive the range of activities as identified in their individual plan Ensure that there are sufficient DS0000008209.V278939.R01.S.doc Timescale for action 30/04/06 30/04/06 3. YA6 15 07/04/06 4. YA9 13(4) and 13(5) 16(2)m,n and 16(3) 16(2)m 07/04/06 5 6 YA12 YA13 07/04/06 30/04/06 Page 30 Chatterley House Version 5.1 7 YA20 18(1)c 8 YA23 13(6) 9 YA26 16(2)c 10 YA30 13(3) 11 YA33 18(1)a and 17 18(1) a YA33 12 13. YA35 18(1)c 14 YA35 18(1)c staff available for service users to access the community Provide training for all staff that administer medication, external to the home and that is formally assessed. (Date shown is the date by which the training should be booked) Provide abuse training for all staff (Date shown is the date by which training should be booked) Discuss with each of the new service users about any additional bedroom furniture that they require Provide information in writing to the Commission showing the extent to which the home meets this standard and accompanying regulation in relation to the laundry and its equipment Retain complete records in the home, and in particular to this standard, maintain written records of all duty rosters. Undertake a review of the staffing hours provided linked to the needs of the service users, and provide a copy of the outcome of the review to the Commission Ensure that the training matrix shows the dates when training was completed and also for when any refresher training is due (This was a previous requirement and has been only partially met) Ensure that all staff receive all mandatory training (including refresher training where this is required). This requirement is for the Commission to receive evidence, with confirmed dates, that all of the staff are booked DS0000008209.V278939.R01.S.doc 31/03/06 31/03/06 07/04/06 07/04/06 20/02/06 17/03/06 07/04/06 31/03/06 Chatterley House Version 5.1 Page 31 15 YA37 18(1)a 16. YA39 24 17. YA42 37 on to the earliest available courses for each topic area. Ensure that the review of staffing 17/03/06 hours includes a review of the hours available for the manager to spend on managerial responsibilities, and list these hours Commence a review of the 30/04/06 services provided by the home and involve the service users in this review. (Follow the points set at Standard 39 for guidance. (This was a previous requirement that was misunderstood by the manager) Notify the Commission in writing 20/02/06 of any Section 37 incidents RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA13 YA6 Good Practice Recommendations Consider providing a notice board to show local amenities, facilities, advocacy services, complaints procedure etc Develop a communication diary for 1 service user Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chatterley House DS0000008209.V278939.R01.S.doc Version 5.1 Page 33 - 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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