CARE HOME ADULTS 18-65
Chatterton Hey House Exchange Street Edenfield Ramsbottom Lancashire BL0 0QH Lead Inspector
Unannounced Inspection 10:00 21 February & 7 March 2006
st th Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 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 Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 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. Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Chatterton Hey House Address Exchange Street Edenfield Ramsbottom Lancashire BL0 0QH 01706 824554 01706 824554 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) The Langley House Trust Mrs Susan Dorothy Heaton Care Home 14 Category(ies) of Past or present drug dependence (14) registration, with number of places Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th September 2005 Brief Description of the Service: Chatterton Hey is a large detached property in its own grounds and is situated in Edenfield on the outskirts of Rawtenstall. The home provides a programme of rehabilitation and accommodation for up to 14 men recovering from substance misuse. This rehabilitation programme usually lasts for 12 months. The house is comfortable with domestic style furnishings and fittings. The accommodation reflects normal living as far as possible and both single and twin-bedded rooms are available. Communal rooms are spacious and a television, music centre and snooker table are available for residents to use in their free time. Residents and staff liaise with local educational services to provide for residents educational needs. Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days. Two additional visits have been made since the last unannounced inspection. One of these visits was to investigate a complaint about staffing levels. Only one part of the complaint was upheld and this was monitored at this inspection. A tour of the premises took place and care records were inspected. At the time of this inspection eleven residents were living at the home. Members of staff on duty and residents were spoken to. Discussions also took place with the deputy manager about issues raised during the inspection. What the service does well: What has improved since the last inspection? What they could do better:
To ensure the needs of the residents are identified and met a care plan must be written on admission to the home. To promote the safety of residents a written procedure of the action to be taken if a resident is reported missing must be developed. Members of staff responsible for the administration of medication must receive appropriate training. This will help to prevent any mishandling of medication. In order to provide effective care for all residents 50 of care staff must have NVQ qualifications appropriate for residents recovering from drug abuse. Staffing levels must improve to ensure sufficient staff are on duty at all times to meet the needs of the residents. A resident must not accompany another resident who requires hospital treatment to A&E. It was evident from discussion with residents that morale was low. One resident said, “It’s a glorified hostel, but safe because there are no drugs.” Another resident said, “I feel as if I’ve been let down.” Several residents
Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 6 expressed concern about the availability of alcohol and residents drinking heavily at night. They considered the action being taken to address this problem to be ineffective. One resident said the problems were due to unstable management and a depleted team. To promote the health and safety of residents an electrical installation certificate must be obtained. Fire alarms and emergency lighting must be tested regularly and records kept. All members of staff must have training in fire safety. Fridge, freezer & food temperatures must be checked and recorded daily. 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. Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 7 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 Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 8 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): EVIDENCE: None of these standards were assessed. Standard 2 was assessed and met at the last inspection. Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 9 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 Although care plans were clearly written not all residents had one. A written procedure to be followed in the event of a resident reported missing was not in place. EVIDENCE: The care records of two residents were inspected. One of these included a care plan, which contained detailed information about the needs of the resident. This care plan was reviewed monthly. The resident met with his key worker weekly to discuss care issues and review progress within the rehabilitation programme. Records of these meetings were seen in the care plan. Appropriate risk assessments had been completed for this resident. Information about how identified risks were dealt with was also included in the care plan. A care plan was not available and risk assessments had not been completed for a recently admitted resident. Although the manager explained that action was taken if a resident was reported missing a written procedure was not available. Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 10 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): 13, 16 and 17 Residents were encouraged to be part of the local community. The rehabilitation programme ensured residents had a structured daily routine. Meals were wholesome and appetising. EVIDENCE: Residents visited the local shops, cinema and leisure centre. Several residents regularly attended a local Church. A number of residents were doing courses at a nearby college. The daily routine was structured as part of the rehabilitation programme. This included education, counselling, household tasks and leisure activities. House rules did not permit residents to lock bedroom doors. Mail had to be opened in front of a member of staff. Residents understood the reasons for these rules and accepted them as part of the rehabilitation programme. The meal served at lunchtime on the first day of the inspection was wholesome and appetising. Residents were responsible for planning and preparing the meals. However, one resident said that he would prefer a healthier diet, which included salads and jacket potatoes. Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 11 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 and 20 Residents were treated with respect. Some members of staff responsible for giving out medication had not received appropriate training potentially putting residents at risk. EVIDENCE: Each resident had a designated key worker. The role of the key worker was to support the resident through the rehabilitation programme. Although residents had to live within the house rules they were treated with respect. Members of staff did not enter resident’s rooms without first knocking and waiting to be told to enter. Medication was stored correctly in locked cupboards in the office. The temperature of these cupboards was checked and recorded daily. Although the residents had given written consent for their medication to kept in these cupboards they were responsible for asking for their medication at the correct time. Members of staff prompted residents to take medication if they forgot. Only one member of staff had received training in the management of medication. An up to date copy of the ‘British National Formulary’ was available for reference. Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Complaints were taken seriously and investigated. Appropriate policies and procedures were in place to ensure the protection of residents and staff at the home EVIDENCE: A copy of the complaints procedure was given to each resident on admission and displayed in the home. One complaint has been made to the home and one to the Commission since the last inspection. Policies and procedures relating to the protection of vulnerable adults, ‘whistle blowing’ and bullying and harassment were in place. Members of staff had received appropriate training. Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 13 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 Residents lived in a clean and comfortable environment. EVIDENCE: At the time of the inspection the home was clean, tidy and well maintained. Residents were responsible for all household tasks including small maintenance jobs and gardening. Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 35 Training for all members of staff was encouraged. However, none of the project workers had obtained appropriate NVQ qualifications. Staff vacancies and absence levels were causing problems, which meant the needs of some residents were not being fully met. EVIDENCE: Discussion with members of staff and the deputy manager confirmed that training was encouraged. This included induction training for new employees, first aid, basic food hygiene, diversity and equality, understanding mental health and drug awareness. One member of staff was an experienced drugs worker and was responsible for leading group sessions. Two members of staff were working towards NVQ level 3. The deputy manager explained that information had been collected from members of staff to enable a training needs assessment to be completed. Examination of the duty rota confirmed that absence levels were causing problems. There were also vacancies for two full time and one part time project workers. Agency staff were covering some shifts. To ensure continuity of care the agency had arranged for the same carers to work at the home. However, at times it was difficult to cover all shifts and occasionally they were short staffed. Langley House Trust were in the process of recruiting staff to fill the vacancies. One resident said he hadn’t had real key worker time since Christmas. Another resident was concerned because a resident had accompanied a resident to A&E at the hospital.
Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 15 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, 38, 39 and 42 Residents were consulted about the quality of the care and services provided at the home. Not all members of staff had received training in fire safety. Appropriate fire and food safety records were not kept. EVIDENCE: At the time of the inspection the manager was on extended leave and the deputy manager was responsible for the day-to-day running of the home. The deputy manager had management experience and was working towards NVQ level 4 in care. This NVQ involved completing four units from the ‘drug and alcohol national operating standards. It was evident from discussion with residents and staff that the availability of alcohol was a problem. There had also been a number of occasions when residents had returned at night after drinking heavily. The residents consulted considered the action being taken to address this problem was ineffective. Senior management within the trust were making arrangements for further managerial support to be put in place. Residents and staff met daily to discuss activities for that day. Residents were encouraged to express any concerns at these meetings. Residents held weekly
Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 16 meetings, which were not attended by any members of staff although the minutes were available for staff to read. The Langley House Trust had a resident’s forum to which resident’s representatives from Chatterton Hey were invited. These meetings took place every three months. Policies and procedures were reviewed and up dated by head office. There was no evidence to suggest that fire alarms and emergency lighting were tested regularly. Not all members of staff had received training in fire safety. A member of staff qualified to administer first aid was on duty for each shift. The electrical installation certificate was out of date. Records of fridge, freezer and food temperatures were not kept. However, basic food hygiene training had been arranged for residents and staff. Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 17 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 2 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Chatterton Hey House Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score 3 2 3 X X 2 X DS0000009512.V269771.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action 1. YA6 15(1) Unless it is impracticable to 07/04/06 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. All residents must have a care plan and appropriate risk assessments. 2. YA9 17(2) A statement of the procedure 26/05/06 Schedule 4 to be followed in the event of accidents or in the event of a service user becoming missing. 3. YA20 13(2) The registered person shall 26/05/06 make arrangements for the, recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. All members of staff responsible for the administration of medication must be given appropriate training. 4 YA32 18(1)(c)(i)(ii) The registered person shall, 30/06/06 having regard to the size of the care home, the statement of purpose and the number
Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 19 5 YA33 18(1)(a) 6. YA38 12(1)(a)(b) 7. YA42 13(4)(a) and needs of service users – (c) ensure that the persons employed by the registered person to work at the care home receive – (i) training appropriate to the work they are to perform; and (ii) suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. 50 of care staff must have an NVQ level 2 or be working towards this by the date given. The registered person shall, 07/04/06 having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Key workers must spend sufficient time with the residents to ensure their needs are met. The registered person shall 28/04/06 ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care, and where appropriate, treatment, education and supervision of service users. The problems with alcohol must be addressed effectively. The registered person shall 28/04/06 ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free
DS0000009512.V269771.R01.S.doc Version 5.0 Page 20 Chatterton Hey House 8. YA42 23(4)(c)(d) 9. YA42 13(3) from hazards to their health and safety. An electrical installation certificate must be obtained. Timescale of 28/10/05 not met. The registered person after 26/05/06 consultation with the fire authority – (c) make adequate arrangements for the maintenance of all fire equipment. Fire alarms and emergency lighting must be tested regularly. Records must be kept. (d) make arrangements for persons working at the care home to receive suitable training in fire prevention. The registered person shall 07/03/06 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Fridge, freezer and food temperatures must be checked and recorded daily. 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 YA 17 YA33 Good Practice Recommendations Individual preferences should be taken into consideration when planning meals. It is strongly recommended that a member of staff should accompany residents who require hospital treatment to accident and emergency. Chatterton Hey House DS0000009512.V269771.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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