Inspection on 24/02/09 for Chaxhill Hall

This inspection was carried out on 24th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chaxhill Hall 04/08/08

Chaxhill Hall 03/08/07

Chaxhill Hall 10/01/07

Chaxhill Hall 08/11/05

Chaxhill Hall 03/08/05

Chaxhill Hall 17/02/05

Chaxhill Hall 19/08/04

Chaxhill Hall 17/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Chaxhill Hall Chaxhill Nr Westbury-on-Severn Glos GL14 1QR Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 24th February 2009 08:00 DS0000016402.V374098.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chaxhill Hall Address Chaxhill Nr Westbury-on-Severn Glos GL14 1QR 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) 01452 760717 01452 760717 Mr Peter Albert Whitehouse Mrs Francesca Beverley Whitehouse Mrs Penelope Iris Jane Merry Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To add a total of 3 beds to be used for service users between the ages of 55yrs - 65yrs. 4th August 2008 Date of last inspection Brief Description of the Service: Chaxhill Hall Care Home is situated alongside the main A48 trunk road between Gloucester and Westbury upon Severn. It is an adapted Victorian house and the accommodation consists of thirty-two single and two double rooms, twenty-two of which have en suite facilities. Communal facilities consist of three large lounges, two on the ground floor and one on the first floor, and two dining rooms. The first floor is accessed by a shaft lift. There is a garden and patio area for people to enjoy in the fine weather. Car parking is available at the front of the building. The home does not have a copy of their Statement of Purpose or Service Users Guide on display. Copies of the homes complaints procedure are in each person’s room and displayed on the notice board in the main entrance. The fees for this home are from £380 to £500 depending on the needs of the person. Additional charges that are not included in the fees are for hairdressing, chiropody and toiletries. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by two inspectors on one day in February 2009. One of these inspectors was a pharmacist and they concentrated on the medication systems used in the home. Before we visited the home we sent surveys to the home in order to obtain the views of people who use the service and staff. We received five back from people who use the service and one from a member of staff. The results of these have been used in the report. We did not request an Annual Quality Assurance Assessment (AQAA) prior to this inspection. We looked at other information we have received from or about the service from other stakeholders. This includes where the home notifies us of any incidents that affects the well being of people who use the service. We looked at a number of systems the service has in place to include care records, activities, food provision, staff supervision and training, complaints, medication and maintenance records. Since the last inspection the Registered Manager has left the home and a new management arrangements have been put in to place. We have found a number of improvements which is excellent, but the service must now sustain these and continue to meet our requirements. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: People considering using the service have their care and support needs assessed by the management team of the home. People who use the service have good access to healthcare professionals. Those people who can decide choose how they spend their day; others rely on staff for direction. Visitors are encouraged and made welcome. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 6 People enjoy a varied diet. People can choose from a variety of freshly prepared dishes. Staff make sure that mealtimes are a pleasant experience for people. People who need support with eating, are helped in a positive and dignified manner. All of the people we were able to speak with made very positive comments about the care and support they received from staff. What has improved since the last inspection? What they could do better: The manager still needs to write to proposed people to confirm if the home can meet their assessed needs. Following this inspection there are some areas in how the staff manage peoples medication that need to be improved to make sure people are not being put at risk. The redecoration and refurbishment of the home needs to continue and the Registered Provider discussed his plans to redecorate the communal lounges. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 7 The guarding of the radiators must continue as matter of urgency to reduce any risks to people who use the service. Systems must be put into place to make sure that soiled linen and continence products are not left in bags on the floor as this is an infection control risk. Whilst the home has provided staff with training in relation to dementia, person centred care and mental capacity act for example which is excellent. The manager must urgently make sure that all staff are up dated with the mandatory subjects to include fire, moving and handling, food safety and first aid. Infection control training would also be beneficial. Further work is needed on the quality assurance systems used by the home as they need to include the views of people who use the service and other stakeholders. Regulation 26 visits that are undertaken by the Registered Provider must take place as directed and a report be sent to us. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives are able to access the information needed to be able to make a decision about the home. A system is in place to make sure people’s needs are assessed prior to admission, however improvements are needed to the recording of some of the information the home receives about prospective people. EVIDENCE: At previous inspections we have had to issues requirements relating to the homes Statement of Purpose and Service Users Guide as they did not contain the information as required in the Care Home Regulations 2001. At this inspection both guides now contained the required information which is excellent. Copies of these are on display in the home. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 10 In surveys that we sent to people we asked them if they had received enough information about the home before they moved in so they could decide it was the right place for them. Five people returned surveys and four people said ‘yes’ and one person said the decision about moving into the home had been made by someone else. We examined the pre admission assessments of two people who were admitted together as an emergency due to the recent heavy snow fall. Both these people were funded by Community and Adult Care Directorate (CACD) and the manager had obtained copies of their care plans prior to both people being admitted. The manager also said that she had a conversation with the Social Worker involved and a representative of both people; however these were not recorded. The manager said that following the discussion with the Social Worker, representative and from reading the CACD care plans, she was confident that the home could meet both people’s needs. The manager did undertake an assessment of both people on admission to the home and she said this confirmed that she felt the home can meet their needs. The manager said the home has a letter they send to proposed people following an assessment of their needs to confirm the home can meet these. A copy of this letter was seen but the manager has not sent one to these two people but is aware she must do this for future admissions to the home. Standard 6 does not apply to Chaxhill Hall as they do not provide intermediate care. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is mostly based on their individual needs, however some improvements are needed to the recording of information in peoples care records. The principles of respect, dignity and privacy are mostly put into practice. Conclusion about medication: There are generally adequate arrangements in place for the management of medicines although we found some weaknesses that need addressing in order to help reduce risks with medication for people living in this home. EVIDENCE: The care of one person was examined in detail and this included reading care records, speaking to the person if able, and staff and observing staff interacting with this person. Two other people had care plans discussed for specific needs. The ongoing assessment of need and care plans are combined Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 12 on one format. The person who had their care examined in detail did have a plan of care for each assessed need but some of these required more detail and directions for staff to follow. This person had their choices included in most of the care plans which is good practice. Monthly reviews have been taking place since November 2008. The two other people required specific care plans to be devised for wandering and how they are managing this and how they are managing one person’s challenging behaviour. During the inspection one person became very agitated and at times verbally aggressive towards staff. Staff were observed to handled this situation very well and used distraction methods. This needs to be documented in a care plan. Risk assessments were in place for moving and handling, falls and pressure area care. The staff will need to devise a risk assessment for the one person who has challenging behaviour and for the other person who is prone to wandering. The person whose care was examined in detail was on a profiling bed and pressure relieving mattress. The mattress is set at the person’s weight but this mattress was set to high and the turn handle to set this was broken. This mattress is supplied by the Community Nurses and it appeared it had not been serviced since June 2007. This was relayed to the manager and she contacted the company immediately. The staff must also make sure that this mattress is set at the correct weight for this person or they place this person at risk of developing pressure sores. Records are in place for any health or social care professional’s that visit people in the home. These include GP, Chiropodist, Community Nurse and Social Worker. Ongoing daily records are also maintained. We asked people in the surveys we sent to the home if they receive the care and support they need, three people said ‘always’ one person said ‘usually’ and one person said ‘sometimes’. One person made a comment “My toilet needs are not met as I need help and it is not always there”. All five people said the staff act on what they say. We also asked if staff are available when you need them, two people said ‘always’, two people said ‘usually’ and one person said ‘sometimes’. One person also commented “There have been times when I needed to speak to staff but they all seem to be on break together”. Four people said ‘always’ receive the medical support they need and one person said ‘sometimes’. One comment we received in the staff survey was that at each shift change staff are provided with a handover so they are kept up to date with any changes to people’s condition and that care plans are updated with any changes usually within 24 hours. We observed that the majority of the time staff treated people with respect. Staff were seen to knock on people’s doors prior to entering. We observed staff speaking to one person whilst they were hoisting them into a chair and telling them what they were doing. We did not receive any concerns from people in Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 13 relation to privacy, dignity and respect. However we did notice that the home uses covers on the seats in the communal areas, this is institutional practice and must cease as with the appropriate continence care these are not required. As part of this key inspection, one of our (The Commission for Social Care Inspection) pharmacist inspectors looked at some of the arrangements for the management of medicines. This included looking at some stocks and storage arrangements for medicines and various records about medication. At lunchtime we saw how staff administered some medicines to people living in the home. The pharmacist spoke to the manager, deputy manager, one person living in the home, one person visiting their relative and visited some bedrooms. We gave full feedback about the arrangements for medication after the inspection to the deputy manager. At the time of the inspection, except for one person who kept an inhaler, no people living in this home were assessed as able to self medicate and look after their medicines. Staff told us this could happen if a risk assessment showed this would be safe for everyone in the home. People living in the home were therefore totally dependent on the staff for this part of their care. Certain carers who had attended a training course about the safe handling of medication administered medication. Medication training and assessment of competence to safely handle medicines must be seen as an ongoing issue. Some parts of the inspection could indicate that further training and competence assessment for dealing with medicines is needed for some staff. We saw there were various times for the administration of medicines to help make sure that doses were spread throughout the day and with a suitable interval between doses. This helps to make sure that the medicines are effective throughout the day and that any risk of harm by receiving doses too close together is reduced. We discussed with the deputy manager about making sure there is at least a four interval between certain medicines (particularly those containing paracetamol) and to consider writing in the actual dose time if the medicine was given at a different time to that printed on the medication records. At lunchtime we saw a member of staff administer some medication for some people who were in the dining rooms having their lunch. We were concerned with some of the practices we saw. One person had eye drops instilled into both eyes whilst he or she was eating their lunch. This does not respect their privacy and dignity. We also saw that medication records were signed as though the doses had been taken when the medicines were prepared at the trolley rather when staff knew that people had actually taken their doses. We noted in one case a cup of liquid medicine was left on the trolley for a long period but the medicine record was already signed as though taken. This was because the dose was poured before the person was ready to take their medicine. This is not good practice and could put people at risk of mistakes Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 14 with their medication. The medicine trolley was at some distance from the second dining room so would have been safer if it was moved closer so that staff did not have to walk too far just with a cup of medicines. We noted that records indicated a few people were given their sleeping tablets at 6pm which seemed early although staff explained why this was. Issues about people’s choices about their medicines like this should be included in care plans. This must now take into account the provisions of the Mental Capacity Act 2005 and should include what choices people have been given and have made about how their medicines are administered. There were arrangements for keeping records about medication received, administered and leaving the home or disposed of (as no longer needed) for each person in the home. Clear, complete and accurate records about medication are very important in a care home where there are a lot of different medicines in use and a number of different staff involved with medication. This is so that people are not at risk from mistakes, such as receiving their medicines incorrectly, and there is a full account of the medicines the home is responsible for on behalf of the people living here. Most of the sample of medicine records we looked at appeared to be in order so that there were clear records about the medicines people living in the home needed and had taken. The particular exceptions were that some of the records about creams and ointments care staff had applied were made inconsistently or not at all so that we could not always tell if and how the prescribed treatments were used. We discussed consideration of alternative ways for recording these treatments so that there is a clear and consistent system that provides complete and accurate records for this. One person was prescribed a more complex treatment with several different creams but there was no care plan for this or records of the application of the various treatments. The directions for some medicines such as eye drops or creams were not always specific. Examples we saw were as to which eye the treatment was to be applied or where, why or how often a cream or ointment was to be applied. We pointed out occasional gaps in the sample of records we looked at where there was no signature so we do not know if the medicine was missed or signing the record was forgotten. There was a standard code letter used to show the reason for missed doses but we pointed out examples where a different letter was used without explanation. If an additional code letter is used an explanation of what this means must be written on the record. Where a variable dose could be administered (one or two tablets for example) the records did not always show what dose had been taken. Most of the medication records were printed each month by the surgery that dispenses the medicines. Sometimes staff had made handwritten additions. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 15 Some of the dates on such records were not clear. As pointed out at previous inspections in order to have a checking system that such handwritten additions have been correctly made these should be witnessed, signed and dated by two authorised members of staff. In order to be fully accountable for all medicines, records must be kept of any medication that comes into the home. This was generally done but there was a person who had come for respite care where these records had not been made making it impossible to properly account for the medicines. Since the last inspection medication assessments have been included in care plans and included information to give staff direction about the use of medicines that were prescribed to use ‘as required’. In some cases, particularly for laxatives and analgesics, these care plans needed more information. The deputy manager was able to explain clearly peoples’ need for some of these medicines but it is important that this is written in care plans so that all staff are aware. We noted that some information in the medication assessments needed reviewing as changes had taken place since they were first written and so were no longer up to date. Sample checks showed that the medicines people living in the home needed were all available although when we spoke to one person they told us that one of their tablets had sometimes not been available. The deputy manager explained this had happened during the recent period of snow when a delivery was delayed by a day. We found two full packs of tablets for one person in the medicine cupboard with an expiry date of September 2008; stock that was in date was in use on the medicine trolley. Some containers of creams or ointments we looked at in bedrooms did not always have a date of opening so it would not be possible to change these regularly to reduce risks from contamination. The label on one tube was so soiled we could not read the label. We carried out some audits, checking that the amounts of medicines in stock agreed with the medicine records. This is one check we can carry out to indicate if people in the home are receiving their medicines correctly and that the medicine records are complete and accurate. We were concerned that checks we made on five different tablets showed that not all could be accounted for. This needs investigation to find out the reason. This was despite the home completing weekly audit check lists for medication and also making counts of tablets each month. These audit checks need reviewing to make sure issues identified at the inspection are picked up and action taken. There were safe storage arrangements for medicines but when creams or ointments are kept in bedrooms there needs to be a risk assessment that this is safe for everyone in the home. A relative expressed concern about the safety of a part used tube found in one bedroom. There were no controlled medicines Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 16 in use at the time of the inspection. There was a proper controlled medicine cupboard provided but we pointed out to the registered provider that he needed to check that this was secured to the wall in the correct way as it appeared to be fixed with screws rather than rag or rawl bolts as specified in the Misuse of Drugs (Safe Custody) Regulations 1973. This is so that should medicines in this category be used in the home in future they can be kept securely in accordance with the law. There was a medicine policy written in 2006 and due for review in November 2007. It is important that this sort of information is detailed, up to date and available to all the relevant staff so that they are provided with proper guidance about how the home expects them to safely handle and manage medicines. It must cover all aspects about dealing with medicines. We saw that some aspects were not included in the policy. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their daily lives. An activities programme has now been put in place but people feel that it does not always meet their expectations. EVIDENCE: Since the last inspection the home has now appointed an activities coordinator for 3 shifts per week. The activities coordinator said she is able to provide group and one to one sessions and is able to undertake a variety of activities with people from exercises to arts and crafts. She also has plans to record people’s social history in their care records. The activities coordinator said she is able to take some people out to the local tea rooms. Church services take place twice monthly at the home for people who wish to take part. A number of people attend day centres and go out to clubs. We asked several people if any activities were due to take place on the day of the inspection and they all said they did not know. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 18 We asked people in the surveys we sent are there activities by the home that you can take part in one person said ‘always’, two people said ‘usually’ and two people said ‘sometimes’. During the tour of parts of the home a number of rooms belonging to people were seen and they had their personal possessions on display. We asked people if they were able to make choices about their daily lives and they said yes within the constraints of living in a care home. Staff were observed offering people choices of drinks and meals. A conversation with the main cook took place. The menus are devised on a four week basis and people are able to make suggestions. A choice is always offered and one of these is a vegetarian option. There are two other cooks who are waiting to undertake their food hygiene training. The staff need to make sure that food records include anything that is not on the menu and sandwich filings and breakfast. A menu board is normally on display but due to redecoration of the main entrance this was not on display. A mealtime was observed in the dining rooms. Staff were offering people choices of drinks and for the meal. Staff were assisting people discreetly and sat down. People were using aids to help them with eating their meals when required. Since the last inspection staff are now hoisting people onto dining room chairs rather than leaving them sat in wheelchairs, which is good practice. We were concerned that the three people who were in their own rooms that required assistance from staff were waiting along time to have their meals. Only one member of staff was allocated to assist them and by nearly 1pm only one of these people had their meal. The manager said that this is an exceptional case as they had staff enrolling for NVQ training and this had put them behind. Normally these three people receive their meals first. We asked people at the inspection if they liked the meals and people said they were very good. We also asked people in the surveys we sent them and one person said ‘always’ and four people said ‘usually’. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and now have access to an effective complaints procedure. However without sufficient records in relation to complaints the home is not always able to demonstrate they have effectively addressed any concerns raised. Systems are in place to protect people from possible risk of harm or abuse. EVIDENCE: People who use the service have a copy of the homes complaint procedure in their Service Users Guide. A copy is also normally on the notice board in the main entrance but this has been removed at the present time due to redecoration. We looked at the complaints the home has received. We aware of the most recent complaint as we were also sent a copy. This is in the process of being completed by external agencies. The home did not have any records of any investigation they have taken into this complaint but the manager was able to show us some actions they have put into place following the complaint. But without records we were not able to see how the staff came to this conclusion and that the actions they have put in place will address the concerns raised in the complaint. Consideration should also be given to maintaining records of any telephone conversations as the manager said she had spoken to other professionals and the family involved. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 20 We also saw a letter that a Social Worker had written to the home saying that another family were happy with the actions the home had put in place to address their concerns. We asked people in the surveys we sent them if they know who to speak to if they are not happy, four people said ‘always’ and one person said ‘usually’. Four out of the five people said they know how to make a complaint. People we spoke to at the inspection said they did not have any complaints about the care they receive. The home has polices and procedures in place for the protection of vulnerable people and these include whistle blowing. The manager said that five of the staff have completed the ‘Alerters’ guide training provided by the local Council and once new dates are issued the rest of the staff will be booked onto this training. Some of the senior staff have undertaken some training on the Mental Capacity Act and Deprivation of Liberty training (DOL’s) which is good practice as the staff in the home will need to incorporate this into care planning and risk assessment. The manager needs to obtain a copy of the ‘Alerters’ guide for the home. We referred one person to the Adult Protection unit at the local Council following a complaint we received about the standard of care this person was receiving. This has now been partly investigated and actions will be put in place by the home to address the any shortfalls once the investigation is completed. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are taking place but parts of the environment are still not safe and along with the actions of some of the staff, people who use the service are potentially being placed at risk. EVIDENCE: Tour of parts of the environment took place with a number of rooms belonging to people viewed. The guarding of radiators is still in progress and this has been now for a number of inspections. This must be completed as a matter of urgency to make sure people are not put at risk of burns from hot surfaces especially as people can be unsteady whilst walking and grab onto the radiators. Some window restrictors in the upstairs lounge may not be set at the correct safety gap to make sure people are safe. The home must put in Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 22 place checks on a frequent basis to make sure the restrictors are still working. Also a number of window catches were missing from windows in the upstairs communal lounge and must be replaced. Redecoration of the home is ongoing and the Registered Provider assured us that this will continue and that they have plans to redecorate the communal lounges, especially as the carpets in both are looking worn and have stains on them. The carpet in the one communal lounge still has the rucks which could place people at risk of tripping. The communal lounge off of the main entrance does need redecorating as the paint work is stained in places and some of the chairs are also heavily stained and need replacing. Cobwebs were seen above the television in this room and this must be addressed. The main entrance to the home had just been repainted and this is a great improvement. One person’s room which is near to the manager’s office (room 23) was viewed and it was found to be odorous and the carpet was heavily stained as was the divan bed. The manager was informed of this during the inspection. There was also no toilet roll holder in their en-suite. Room 28 was also found to be odorous. Room 12 the carpet was stained and flooring in the en-suite was coming away from the floor, again these need to be addressed as a matter of urgency. During the tour of the home black bin bags were seen left on the floor outside people’s rooms as well as ‘tiger’ bags that contained soiled continence products. Peoples clothing was found to be in the black bin bags. To leave these bags on the floor unattended is poor infection control and as the home have people that wander they could pick up these bags and touched the soiled continence products. The staff must make sure that these are not left on the floor and black bin bags should not be used for clothing in case they are thrown away. Consideration should be given to obtaining a trolley to place these bags on. The laundry area was not examined at this inspection. Protective clothing is available for staff to use and this includes gloves and aprons. Staff were observed to wearing this when required and especially when entering the kitchen area. Following the last inspection both the local Environmental Health Department and Fire Service were contacted with our concerns. Both of these agencies have visited the home and have written to the home with their findings. In the surveys we sent to people we asked them is the home clean and fresh, four people said ‘usually’ and one person said ‘sometimes’. We also received a number of comments. One person had written in relation to, is the home clean and fresh “Depends on the time of the day and staff levels”. Other comments “no soap in bathrooms and towels do not seem very clean, front door not very secure worried about safety”, “TV lounge smells of urine” and “The home could do with a facial to make it lighter and brighter for relatives. Lounges and couple of bathrooms need updating”. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is confident that they have sufficient numbers of staff to meet peoples assessed needs. However without a structured training programme the home cannot be confident that staff have the skills and knowledge to meet people’s needs competently. EVIDENCE: The duty rotas were examined with the manager and she is confident that the numbers of staff on duty are meeting the needs of people who use the service. Ancillary staff are also employed to assist the care staff. The care staff also undertake non-care tasks to include food preparation and some laundry. The care staff on the afternoon shift assists in the preparation of the evening meal and the night staff also help with preparation of the vegetables. Consideration should be given to stopping the night staff from preparing the vegetables as best practice would suggest that vegetables prepared this far in advance may lose some of their goodness. The manager needs to make sure that the care of people who use the service is not being compromised whilst care staff undertake these additional non-care tasks. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 24 The manager said she is extra to the staffing numbers. It was noticed that two members of care staff are undertaking 14 hour shifts on a weekly basis, this is not advisable but the manager said this has been taking place for a number of years. The feedback we received from people who use the service about the staff was very positive. People said they were helpful and friendly. Staff spoken to and the comments we received in the staff survey is that it is a friendly place to work with good support from the management of the home. One staff comment was “I feel we try to cater for the individual as much as possible and that we offer a safe and above all friendly environment people can feel comfortable in”. The number of staff that have completed or are undertaking an NVQ 2 or above in Health and Social Care exceeds the recommended 50 , which is excellent. Three personnel files were examined of staff that had started work at the home since the last inspection. All contained the required recruitment checks except none of them had a full employment history and one member of staff had used years in their employment history, but they must be more specific. There was no evidence that the gaps in these staff members employment history has been discussed at interview. All Protection of Vulnerable Adults (POVA) checks were in place prior to the staff members starting work at the home and two of these also had their full Criminal Records Bureau Disclosure (CRB) in place. The induction training used by the home was examined. The manager said this is a basic course and staff are not allowed to undertake moving and handling until they have complete it. This course is not based on the Skills for Care common induction standards and the home is not registered for this. Evidence was seen of new staff undertaking this course and new staff are assigned mentors and this was recorded on the duty rotas. Two staff files were randomly selected to look at their training. From the records seen it would appear that some members of staff have not had training in moving and handling since 2003 and other mandatory training is also out of date. The manager said they are looking to appoint a training company for all the mandatory training. The home is involved with the Care Home Support team and they have provided training on a number of subjects to include dementia, person centre care and falls. Training is planned in March for sensory deprivation. Staff spoken with and in the survey we received said that training courses are available. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new management team have a supportive open approach to running the home. Once an effective quality assurance system is in place this will help the manager to run this home in the best interests of people who use the service. EVIDENCE: Since the last inspection the Registered Manager has left the home and the previous deputy manager has now become the manager and a new deputy manager has been appointed. However the new manager is going onto maternity leave shortly so the new deputy manager will become the manager. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 26 The Registered Provider confirmed that she will be applying to us to be considered for registration. Staff spoken with and in the staff survey we received all said that the management are supportive and one member of staff said that they have seen improvements in the home with the new managers. Since the last inspection we found improvements but as the manager is now going onto maternity leave the new manager will need to make sure that they can sustain these improvements and continue to meet our requirements. The manager was able to provide evidence that auditing is taking place for some areas and these include people’s room and to make sure they are receiving activities and baths etc. The manager should consider bringing in auditing that covers the environment as a whole, food provision and peoples views on the service. We also did not see any evidence on how the home obtains views of people who use the service and other stakeholder. Regulation 26 visits, this is where the Registered Provider or representative on their behalf undertakes monthly visits to the home and completes a report focusing on a number of areas. These were found not to be taking place monthly and we are not receiving the reports as required under this regulation. Due to the homes previous rating of poor in August 2008 we want to see that the home is continuing to improve therefore these reports must be sent to us and contain the information as set out in this regulation. The home has safe system in place for managing people’s monies and auditing of these takes place. Consideration should be given to asking 2 members of staff to sign any transactions as well as the person if able for safety. Since the last inspection staff supervision sessions have been put into place. Three care staff files were randomly selected to check on the frequency and if the sessions had been recorded. Since the beginning of this year most staff have had two sessions and development plans were put into place last year. Plans are also in place to provide the ancillary staff with supervision sessions every six weeks. This is an improvement and must be sustained especially for the care staff. Information regarding the servicing of equipment was examined; no records were seen for servicing of boilers or an electrical wiring test. Weekly checks of water temperatures were in place and the home needs to consider checking the wheelchairs and window restrictors. The local Environmental Health Department are due to re-visit the home shortly and the Fire Service. The manager does need to devise a fire evacuation procedure as a matter of urgency. As mentioned previously the guarding of all radiators must continue again as a matter of urgency to make sure people are not being put at unnecessary risk. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 27 Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 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. Standard OP7 Regulation 15 Requirement The registered person must ensure that people who use the service have care plans devised for all identified needs, and these are kept updated to reflect their current needs. This is to ensure that the staff in the home has the information required to meet people’s needs. The care plans must direct the care. (This requirement remains outstanding since the last inspection but there is some progress in place to meeting this in full.) The registered person must devise risk assessments as detailed in the text in the outcome group of health and personal care. This will help to make sure that the staff have assessed the risk and put actions in place to help minimise these. Timescale for action 30/07/09 2. OP8 15 31/05/09 Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 30 3. OP9 13 When medicines are administered to people living in the home staff must always follow practices that are safe and respect the choices, privacy and dignity of people who live in the home. This will make sure that people’s wishes about their medicines are respected and they are not put at unnecessary risk from medicines because of poor practices. When any medication is administered to people who live in the home it must always be clearly and accurately recorded. (This particularly relates to records for prescribed treatments applied to the skin and to the shortfalls identified in the report). This is to help to make sure people receive their prescribed medication correctly and to help reduce risks of mistakes. 31/05/09 4. OP9 13 31/05/09 Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 31 5. OP9 13 Review medicine records and 31/05/09 care plans for people living in the home to make sure that for all medicines prescribed with a direction when required or with a variable dose there is clear, up to date and detailed written guidance available to staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. (This particularly relates to some care plans not including all medicines prescribed ‘when required’ or some not including enough information to guide staff.) This will help to make sure that there is some consistency for people in the home to receive medication when necessary and in line with planned actions. Take action to make sure effective and accurate routine audit checks are in place with written evidence of these. This is to make sure that all medicines the home handle on behalf of people living here are properly accounted for. 31/05/09 6. OP9 13 7. OP12 12 The registered person must 10/05/09 make sure that the home is run in a manner that respects people’s privacy and dignity. This is in relation to the institutional practice of using seat covers in the communal areas. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 32 8. OP19 23 The registered person must ensure that the premises are of sound construction, kept in a good state of repair internally and externally and kept reasonably decorated. (This relates to the carpet with rucks. It must be re-laid or replaced.) The registered person must make sure that soiled linen and continence products are not left in bags on the floor as this places people at risk of cross infection. The registered person must make sure that all odours are eliminated so that people live in comfortable environment. The registered person must make sure that all the required recruitment checks are in place prior to a new member of staff starting work at the home. This is particularly looking at a full employment history with any gaps in this explored and a satisfactory written explanation for this. This will help to make sure that people who use the service are not put at any unnecessary risk. The registered person must make sure that staff receive training for the tasks they are to perform. This will help to make sure that staff have the knowledge and skills required to meet peoples assessed needs. 31/05/09 9. OP26 13 10/05/09 10. OP26 16 10/05/09 11. OP29 19 31/05/09 12. OP30 18 30/07/09 Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 33 13. OP31 8 The registered person must 30/06/09 make sure that the new manager applies to us to be considered for registration. The registered person must make sure that the monthly unannounced visits are taking place as directed in this regulation and a copy of the report is sent to us at our Bristol address. This will help to make sure that that the home is monitored and audited and it is being run in the best interests of people who use the service. The registered person must make sure they have addressed the requirements issued by the Fire service. This will help to make sure that the home has put systems in place to protect people if a fire was to occur. 31/05/09 14. OP33 26 15. OP38 23 31/05/09 16. OP38 13 The person registered must 30/06/09 continue with the programme of guarding radiators so that people are not at risk of scalding if they should fall against the hot surface. This requirement remains outstanding since the last inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 34 No. 1. 2 Refer to Standard OP3 Good Practice Recommendations The staff should record any telephone calls they have with relatives/representatives and professionals’ as part of a pre admission assessment. Make sure that care plans reflect what choices people who live in the home are given and have made about how their medicines are handled and their consent to the way in which staff administer their medicines. Make sure that when any handwritten entry is made on medicine charts this is signed and dated by the member of staff writing this with a second member of staff checking and signing as correct. Write the date on any containers of medicines when they are first opened to use. This helps with good stock rotation in accordance with the manufacturers’ or good practice directions and with audit checks that the right amount of medicines are in stock. Carry out written risk assessments to make sure that when any prescribed creams, ointments and other preparations applied to the skin are kept in bedrooms this is safe for everyone in the home. Review and update the medicine policy and local procedures to make sure this includes all aspects for the safe handling of medicines. This is so as to provide all staff with precise direction about the way medicines are safely managed and handled in this home. The home should have a programme of redecoration in place to improve the environment for service users. (In good progress). Outstanding since last inspection. The home should check window restrictors to ensure they are the correct width to reduce the risk of people falling out of the windows. (Outstanding since the last inspection.) The home should devise a training matrix. (Outstanding from last two inspections). The home should register with the Skills for Care. The home should ensure that all the required maintenance and checks by contractors are up to date. Outstanding since the last inspection. OP9 3 OP9 4 OP9 5 OP9 6 OP9 7. 8. OP19 OP19 9. 10. 11. OP30 OP30 OP38 Chaxhill Hall DS0000016402.V374098.R01.S.doc Version 5.2 Page 35 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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