Inspection on 04/08/08 for Chaxhill Hall

This inspection was carried out on 4th August 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chaxhill Hall 24/02/09

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 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Chaxhill Hall Chaxhill Nr Westbury-on-Severn Glos GL14 1QR Lead Inspector Sally Walker Key Unannounced Inspection 09:15 4th August 2008 X10015.doc Version 1.40 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 Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Chaxhill Hall DS0000016402.V369185.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 F/P 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.V369185.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. 3rd August 2007 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 £330 to £480 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.V369185.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 0 star. This means the people who use this service experience poor quality outcomes. This unannounced Key Inspection took place on 4th August 2008 between 9.15am and 5.20pm. Mrs Merry was present for the morning of the inspection. We gave Mrs Merry feedback over the telephone the following day. We asked Mrs Merry to complete an Annual Quality Assurance Assessment (AQAA). It was received on time and completed in part. It gave us very little information about what the home considers that is does well or any plans for improvement. As part of the inspection process we sent survey forms to the home for residents, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. We spoke with four people who use the service, four relatives and four staff. We made a tour of the building. We looked at care records, medication records, menus, staffing records, the statement of purpose and service users guide. 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 either the manager or deputy manager. 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. 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. Relatives told us that their complaint had been actioned to their satisfaction. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 6 The laundry is well managed and people have a good laundry service. 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 statement of purpose and service users guide must be kept up to date to show what people can expect from the service. The home needs to write to new people following the pre-admission process to tell them whether their care and support needs can be met by the home. The pre-admission assessment would benefit from ways to capture people’s social history and needs. This is particularly so, where people cannot remember or talk about what they like to do. Consideration should be given to whether the home makes an application to vary the category of registration to include dementia. Care plans must direct the care, showing detailed guidance on how assessed needs are to be met and monitored. Where immediate care charts are in place, such as turning charts, they must state what staff intervention is expected during the day at different times. Food or fluid charts must also Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 7 state what is to be achieved during the day. These charts must be fully completed and totalled for monitoring purposes. Staff must be encouraged to consider best practice in how they provide care and support to people. People should be offered armchairs to sit in rather than being left in wheelchairs either in the sitting rooms or at the dining table. The new tool for assessing people’s risk of developing pressure damage must be implemented. Staff must be encouraged to use any communication tools that people have. Medication should not be handled by staff to avoid contamination. The medication administration records must be securely stored. An audit of the stocks of medication must be carried out to identify any discrepancies or errors. Handwritten entries in the medication administration records should be witnessed, signed and dated by two staff. A record should be kept of all unused or unwanted medication at the time that this is noted. Details of medication prescribed to be taken only when needed must be included in care plans. The record must show what prompts an administration. Where bed rails are used, the care plan and risk assessment must record those involved in the decision about their use. People have very little opportunity to engage in meaningful activities save that provided by their relatives. If training courses in safeguarding adults are not available, alternative courses must be sought. The home’s procedure for recognising and reporting abuse must be readily available. The home is not regularly cleaned to a good standard in some areas, particularly the kitchen. The brown carpet in one of the sitting rooms that has rucks in it must be replaced so that people are not at risk of tripping and falling. Staff must have regular supervision to ensure that they have the opportunity to discuss their practice, the philosophy of the home and any training needs. We are concerned that requirements have not been complied with since the last three and in some cases four inspections. Unmet requirements impact upon the welfare and safety of people who use the service. We have sent the registered provider a warning letter and an improvement plan. Failure to comply with the requirements by the revised timescales will result in us taking enforcement action to secure compliance. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 9 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.V369185.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Outdated information is available to people considering using the service. People do not necessarily know that the home can meet their assessed needs. Basic assessments of people’s care needs are being carried out. EVIDENCE: No action had been taken to meet the requirement we made that the Statement of Purpose and the Service Users Guide must be amended to include details described in Standard 1. The details are: • The experience and any qualifications of the registered provider. • The organisational structure of the home. • The procedure for emergency admissions. • Other associated emergency procedures in the home. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 11 No action had been taken to meet the requirement we made that the Service Users Guide must be updated to include information about the fees described in regulation 5. We said that the Service Users Guide requires additions to the home’s terms and conditions. These are: • The arrangements in place for charging and paying for any additional services. • A statement as to whether it would be different for a person whose care is funded in part or whole by another source other than by the person themselves. Mrs Merry told us that she had revised these documents and sent a copy to us. During the inspection Mrs Merry gave us a copy of these documents from her files. We saw that they had not been reviewed and revised to show the above details. The service users guide related to a previous manager and a previous regulatory authority. No action had been taken to meet the requirement we made that the home must write to people who are considering using the service confirming that the home is suitable for meeting their care, health and welfare needs. Mrs Merry told us that the only recent admissions had been for respite care. We did not find written confirmation that the home was suitable for their needs. Action had been taken to address the good practice recommendation we made that all sections of the pre-admission assessment are completed, dated and signed by the person completing them. The home’s assessments showed little detail of care needs or history. The assessments were based on physical needs and contained little social history. One of the assessment documents was a list of statements to be circled. Care management assessments were in place. We spoke with a relative of one of the people using the respite service. They told us that they had visited the home before their relative used the service. They said they had been shown a different bedroom to the one their relieve was currently using. From discussions with people who use the service and observations we noted that some people may have some degree of dementia. Mrs Merry told us that some people had developed a dementia since residing at the home. She told us that she would not consider anyone who had a diagnosis of dementia. Mrs Merry also told us that she was considering a variation in the home’s registration to include some places for people with dementia. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans are limited in detail of how the assessed needs are to be met. People have access to local healthcare services. There is very little monitoring of the home’s own plan for people’s heath care. Care plans do not direct the care. People are not always protected by the home’s procedures for managing their medication. Some staff do not automatically consider people’s need for respect and dignity. EVIDENCE: Some action had been taken to meet the requirement we made that care plans record details of all the current needs of each individual person who uses the service. We said that these must be updated so that staff have the information required to meet people’s needs. In the AQAA Mrs Merry told us that ‘minimum detailed daily care sheets’ had been discretely placed in each person’s room for staff to follow. She told us that staff are expected to sign a Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 13 check sheet for monitoring their intervention in relation to the care plans. The AQAA stated that where there were shortfalls, staff would be given supervision or training. We saw that a limited care plan was in place for a person who was using the respite service. The person’s risk of developing pressure damage had been assessed. The form for managing the risk was blank. A moving and handling assessment had been completed. There was clear information that the person followed a diabetic diet. We saw limited guidance on how some care needs were to be met. For example: “if becomes aggressive on waking leave if safe to do so.” We also saw some positive statements in people’s care plans, such as “needs wheelchair for long distances.” We spoke with a relative who told us they attended reviews of their relative’s care plan. We saw some people who were in bed. They had pressure-relieving equipment in place. There were immediate care charts in their rooms. These were to record when people were turned in their beds and their food and fluid intake. One person we visited at 10.15am appeared to have a dry mouth and be thirsty. Mrs Merry gave them a full glass of juice. We looked at their care chart. The last entry was for 6.30am. Mrs Merry said that the person was to be turned every two hours. She said that staff would have attended to the person since this entry but had failed to record what their intervention had been. We advised that the chart should have an accompanying plan of when each person should be turned and how much their ideal fluid intake should be, for monitoring purposes. We advised that all drinking vessels should be measured so that the actual amount taken could be established, rather than just recording ‘cup of tea’. We went back later to this person’s chart and saw an entry timed at 10.30am to say that the person was up and dressed and had had a drink. The visiting district nurse said that none of the people using the service had pressure sores. They said they were dressing a skin tear. We looked at the person’s care plan and daily notes. There was no reference to this wound or how it was being treated or any progress in healing. When we talked to staff they were able to talk about the wound. We saw staff attending to one of the people who had no speech and looked very frail. They were bringing the person down from their bedroom to the sitting room. We saw them place their hands on the person’s calves to put their feet on the wheelchair footrests. They also put a jumper on the person. At no time during this did they tell the person what they were about to do. We later saw this person in a chair in the sitting room. They were bent over and had their head on the side of the armrest. They were still sitting on the sling used to hoist them into the chair. We told Mrs Merry that this person did not look at all comfortable in their chair. She made the person more comfortable, talking to them throughout and explained what she was about to do and removed the sling. We later saw this person being hoisted from the chair to a Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 14 wheelchair. Again the staff made no effort to explain the process to the person. We looked at this person’s care chart in their bedroom. Their care plan stated that they must have two hourly turns throughout the night to reduce the risk of pressure damage. We saw that the chart for the previous night was filled out for 10pm the previous evening and for 6am that morning. There was no record as to whether the care plan had been followed. There was also a care chart from December 2007 stuck to the door of their ensuite. Their care plan stated “comes down for 2 – 3 hours a day. Sits in lounge in recliner on pressure cushion.” We saw that the person was sitting on a pressure-relieving cushion, but they had been placed in an ordinary chair. There was little evidence of other preventative measures. Their care plan for pressure area care stated “sudo-crem to affected areas (any red areas). Report any changes.” Clearly this is too late as damage may have already occurred. Action had been taken to address the good practice requirement we made that the Waterlow risk assessment tool should not be used until all care staff that use it are trained in its use. In the AQAA Mrs Merry told us that a new pressure damage assessment tool would be introduced in the next two months. We saw one person who had been left in a wheelchair by the fire exit in one of the sitting rooms. We saw some people in wheelchairs rather than in dining chairs at lunch time. We spoke with a staff member about their asking one person if they needed to use the toilet in a loud voice. They told us they had to talk loudly as the person could not hear. They said this was what they had been told to do. We discussed with them finding different solutions to ensure that people’s privacy and dignity were not compromised in a public space. We tried to make ourselves understood to one person who had hearing difficulties. We wrote our questions down. The person read and answered all our questions and had a conversation with us. Later we saw that one of the newer staff got writing paper saying they were explaining something to this person. One of the other staff told us that flashcards were used with this person. We found no evidence of the cards in the person’s room. They did not have a supply of writing material with them for staff or others to communicate with them. One of the people we spoke with told us that the GP would be called whenever needed. One of the relatives told us that they had not been contacted when their relative had seen their GP. They went on to say that this had been pointed out and was much improved. Their wishes were now identified in the care plan and staff made contact when needed. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 15 We looked at the arrangements for administering and storage of medication. Medication is administered from original packs. Staff checked the record before giving medication. We saw that staff put the medication into their hand before putting it in a pot to take to each person. We advise that medication is administered straight into the pot to avoid contamination. We also advised that the medication administration record was kept securely. This was immediately addressed by locking it in the drug trolley. We saw that staff locked the medicine trolley when leaving it unattended. We noted gaps in some administration records. We also saw that handwritten entries in the medication administration record were not always witnessed, signed and dated by 2 staff. We saw that the stocks and record for one medication did not correspond. We advised that urgent audit of medication must be carried out. Mrs Merry told us that she or the deputy manager regularly carry out monthly medication audits. We saw that there was a pot of unused or unwanted medication in the drug trolley yet the disposal record only showed 1 record for 2008. We advised that a record is made at the time that any medication becomes unwanted for monitoring purposes. No action had been taken to address the good practice recommendation we made that any ‘prn’ medication is included in their care plan. This would ensure that staff know when to give medication prescribed to be taken only when needed. We looked at the medication administration records and related ‘prn’ medication to care plans. We saw that paracetamol was recorded in one care plan to be taken for pain. There was no further detail as to what pain was experienced by the person. There was no detail as to whether the person could communicate to staff that they were experiencing pain. Another care plan stated “staff to give prescribed medication” in relation to their ‘prn’ medication. Another person’s care plan stated that they were not receiving any medication yet the medication administration record showed that they were prescribed paracetamol. We saw that there was a spare inhaler in the medication trolley for one person who self administered this medication. As a matter of good practice the home has a copy of the British Pharmaceutical Society’s Formulary for staff reference about the properties of people’s medication. We saw that some people had hospital type beds. Bed rails were being used with bumpers in place to protect them from harming themselves on the rails. One persons care plan recorded that a mattress was placed on the floor at the side of the bed so that if they fell this would reduce any injury. Another person had a risk assessment with regard to use of the bedrails that stated “covers to be used at all times”. There was no other detail about how the rails should be used or who had agreed to their use. In survey forms people were asked whether they received the care and support they needed. One person answered “usually”. Another person said “always” and another person said “sometimes”. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 16 In survey forms, five staff said they always were given enough information about the needs of people they cared for. Staff were asked if the ways in which they passed information about people who use the service between them and the manager worked well. Four staff said they “usually” worked. Staff told us in the surveys of their concerns about being short staffed, especially when staff had sick leave. Chaxhill Hall DS0000016402.V369185.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor for standards 12 to 14, but good for standard 15. This judgement has been made using available evidence including a visit to this service. People’s social and leisure needs are not a priority. The home relies on relatives to take people out and spend time with people. There is little emphasis on encouraging people to make choices about their lives. A good range of appetising meals is provided. EVIDENCE: One person told us they followed their own routines and could get up and go to bed when they liked. They told us the home was “low on activities” but they would go out with their daughter. Another person told us that there were not as many outings now as there used to be. They said there used to be at least two or three a year. They told us they had been to Weston super Mare and had a pub lunch. Those people who can decide choose how they spend their day, others rely on staff for direction. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 18 Little action had been taken to address the requirement we made that the home must consult and provide a programme of activities for people. We found little evidence that people were provided with any meaningful or suitable activities. Some people were sat in one of the sitting rooms. Other people were in their bedrooms. One of the staff told us that they had taken one person for a walk around the garden because they were becoming anxious. The home relies on visiting relatives to take people out and spend time chatting to people. Mrs Merry told us that an activities co-ordinator was to be employed. We talked with one relative who had come to take their relative out. They made positive comments about the care and support provided. We talked with another relative who told us they could visit at any time and were always made welcome. We saw many relatives visiting during the day. We saw photographs of people making Christmas cards displayed in the entrance hall. One person had facilities in their bedroom to make hot drinks. There was little evidence either from observation or in the records that people are supported to make decisions about their daily lives. In the AQAA Mrs Merry told us that a new cook had been employed. They had completed a food and nutrition training day. The cook told us they had had a four week induction and had undertaken food hygiene training in February of this year. They said they catered for vegetarian and diabetic diets. We saw the four week menus. There was a good range of choices for each meal on most days. There was a hot meal in the evenings. The lunch was faggots or toad in the hole. There was a vegetarian option of sausages. The cook said the faggots had come from the local butcher. We saw that the meal was well presented and looked appetising. Staff were asking people what they wanted as the meal was served. Staff were supporting some people with eating their meal. Those people who were being fed by staff had their meal given at their own pace. Staff were chatting with them to encourage them to eat. The meal was unhurried. Staff were making sure that the meal was pleasant for people. We saw a good choice of pasties, sandwiches and cake for the evening meal. The cook had made the cake. All of the people we spoke with made very positive comments about the food. One person described a black forest cake that they especially liked. They said the cook made very good pastry and there was always plenty of vegetables and fruit. Another person told us that their breakfast was brought at 6.50am which they considered too early. They also said that sometimes their lunch was not very hot. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 19 In a survey form one person said: “at the end of August a carer is being engaged to provide activities for us.” They were asked if they liked the meals. They answered “sometimes” and commented “some of the meals are second rate, the meat is nearly always tough and we dont have a professional cook. Several of the residents have dementia and they disturb the peace of the home, the meals are rarely served on time and we sit for half an hour sometimes waiting to be served”. Another person said they always liked the meals. A third person said “usually and sometimes” to the same question. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure stating how people’s complaints will be addressed. The home’s safeguarding procedure was not readily available. Some staff are not aware of how their actions can be seen as abusive to people who use the service. EVIDENCE: The complaints procedure is displayed in the home. There was little information in the AQAA about how the home is managing complaints and protection. The AQAA stated “complaints policy and procedure are included in the service users guide”. We were told that the policy and procedure was last updated in May 2008. There has been a recent complaint that was investigated by the Community and Adult Care Directorate. We spoke with a relative who told us that their concerns had been addressed to their satisfaction. Mrs Merry told us that locks had been fitted to bedroom doors following people complaining about other people coming into their bedrooms uninvited. We could not establish whether action has been taken to address the requirement we made that the home’s adult protection policy is updated with Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 21 the latest legislation. We had said that the policy must contain detailed information about the types of abuse. The policy could not be found. Mrs Merry told us that they would use the policy information in the new quality assurance documentation. We had advised that staff should attend the ‘Alerters’ training provided by the local Council. Mrs Merry told us that she had sought this training but is was no longer available. We advised that alternative training must be sought. We talked with some staff about what they would do if they witnessed abuse of people who use the service. Whilst staff knew that they should report any concerns to management, we advised that they should know about the local process. One of the staff told us they had received training in recognising abuse in their previous employment. We saw that some staff did not always treat people with respect and dignity whilst caring for them. See section 7 to 10, Health and Personal Care above. In survey forms two people told us they knew how to make a complaint. One person wrote: “someone is not always available and not always passed to the Manager and not always acted upon”. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some progress is being made in re-decorating the environment for people’s comfort. People are at risk from poor fire safety management. Some safety issues had not been addressed as a matter of urgency. Some areas of the home do not benefit from regular cleaning. EVIDENCE: Some progress had been made in meeting the requirement we made that the premises must be kept in a good state of repair and reasonably decorated. We had made two good practice recommendations. The first was that the home has a programme of redecoration in place to improve the environment for people. The second was that the home should ensure that all the required maintenance and checks by contractors are up to date. We had asked for the Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 23 home’s plan of refurbishment to be sent to us. This was not done. In the AQAA Mrs Merry told us that the home is being refurbished on a rolling programme. She said that a maintenance book is checked daily by the maintenance person. Mrs Merry told us that eight bedrooms had been refurbished, two corridors had been re-decorated, the roof had been repaired and the laundry floor had been repainted. We saw that the grey paint on the laundry floor had worn away showing the red paint underneath. Later in the day the maintenance person confirmed that they were re-painting the floor. The laundry was well organised. A member of staff attends to the laundry every weekday between 9am and 2pm. A cleaner works in the laundry from 8am to 2pm on a Saturday. At other times care staff carryout laundry duties. The night staff also carry out laundry duties. A new laundry trolley had been purchased. At the last inspection we said that the home should check the gaps of window openings on the first floor. This is to ensure that they are the correct width so that people cannot open the windows wide enough to fall or get out. We saw that chains had been fixed to some of these windows. We saw two windows in the corridor on the first floor had not been restricted. Later in the day Mrs Merry arranged for those windows to have restrictors fitted. We said that this should have been addressed when it was first noted rather than wait until we inspected again. Mrs Merry told us that casement stays had been ordered for all windows. She also told us that the contract to service the fire extinguishers had recently been renewed. Mrs Merry told us that all the radiators in people’s bedrooms had been guarded. This is so that people are not at risk of scalding should they fall against them. She said that the radiators in the ensuite facilities were gradually being guarded. Other radiators are also to be fitted with guards. One person told us that locks had been fitted to bedroom doors. They told us about an experience they had had where another person who lived there came into their bedroom uninvited. Mrs Merry showed us the contractor’s letter confirming that tests had been carried out on the water supply and fittings to ensure that Legionella is not present. We noted that some of the corridors and staircases in the newer part of the home had been redecorated and new carpets laid. Mrs Merry showed us the other areas that were due to be re-decorated. She showed us one of the bathrooms where the non-slip flooring had come away from the wall and was lifting up. She told us this would be replaced. We saw that the upstairs sitting room carpet had deposits of hair on it from when the hairdresser visited four days before. A brown carpet with rucks in it, Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 24 identified at the last inspection had been replaced. However we saw another carpet in one of the sitting rooms with rucks in. People remain at risk of tripping and falling over the uneven surface. We saw that many of the bedrooms and corridors were in need of vacuuming. We later saw these areas being addressed. We spoke with a relative who told us they felt the home “could do with a clean”. They showed us dust on the surfaces and specks on the carpet in their relative’s bedroom. We saw that there were no rubbish bins in any of the bathrooms or toilets. We were told that this was because they had been urinated in and removed. We saw that the undersides of toilet surrounds had brown drip marks. We saw that the undersides of bath hoists had a build up of lime scale and brown deposits. Some action had been taken to address the requirement we made that all parts of the home are free from offensive odours. This is to ensure that people live in a pleasant environment. We noted a vague smell of urine as we entered the home. We noted a strong smell of urine in the laundry. There were no other offensive odours detected in any other areas. In the AQAA Mrs Merry told us that the garden is to be secured so that people can go outside safely. We noted that a large number of fire doors and other doors were being held open with the use of pieces of wood. This means that the people who use the service and staff are not protected in the event of a fire. Mrs Merry told us that approval for the use of these wedges had been given by the Fire and Rescue Service, but there was no written evidence of this. We said that in the event of a fire the home could not guarantee that these wedges would be removed to stop fire and smoke permeating the building. We are writing to the local Fire and Rescue Service to inform them of what we found. We found that the kitchen floor, pantry and fridge were in need of attention. There was debris on the pantry shelves. We said that this could be minimised if the dry good were stored in plastic containers rather than in their original paper cartons. We saw that although the items stored in the fridge were covered and dated, there was debris on the bottom shelf. The locked container used to store medicines had green mould growing on the surface. The cook immediately cleaned the surface. We looked for the kitchen cleaning schedules but they were unavailable. It was clear from talking to the cook that they had little opportunity in their part time role to attend to thorough cleaning of the kitchen. The cleanliness of the kitchen must now be addressed. We are writing to the local Environmental Health Department to tell them what we found. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 25 Two of the staff told us that the security lights were not working at the front of the building. They told us that staff felt this compromised their safety when waiting for lifts or buses in the dark at the end of their shifts. Mrs Merry told us that she would attend to the matter. In survey forms two people said the home was “usually” fresh and clean. Another person said: “sometimes” to the same question and commented: “could be better soap dispensers, need to be filled regularly and need bins in the bathrooms. Nice to see new carpets and decor”. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is confident that the numbers of staff on duty meet the needs of people who use the service. Staff have access to basic training as the need arises. At least 50 of staff have NVQ Level 2 or above. The recruitment records do not always evidence that a robust process is in place. EVIDENCE: There were four permanent members of staff on duty with two new members of staff working on the morning of the inspection. There were also two cleaners, the cook and the laundry person. There are two waking night staff. No action has been taken to address the good practice recommendation we made that a training matrix is devised. Mrs Merry told us that she was arranging training for staff from a prospectus provided by the local authority and another training provider. She also told us that training would also be provided on the information and policies within the new quality assurance pack that had been purchased. In the AQAA Mrs Merry told us that staff are receiving training in dementia, the Mental Capacity Act 2005 and deprivation of liberty. She said that at least Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 27 50 of staff hold an NVQ Level 2 or above. The AQAA stated that induction training has improved and is better recorded. Staff training certificates were displayed in the entrance hall. Staff had recently been trained in person centred care, first aid, the Mental Capacity Act 2005, continence, nutrition and dementia awareness. One of the newer staff told us about the training they had undertaken in their previous employment with a different client group. They told us they had had a day’s induction at Chaxhill Hall. Little action has been taken to address the good practice recommendation we made that the home should register with the Skills for Care. Mrs Merry told us that this had been done and she had been given a password which did not work. She later told us that the home did not have internet access. Action had been taken to address the requirement we made that a full employment history is obtained on all proposed staff with written explanation of any gaps in employment. Employment files showed records of interview notes. All the other information and documentation required by regulation was in place except current photographs of staff. Mrs Merry said she would attend to this. No staff commenced duties without checks on their suitability to work with vulnerable people. One new staff had commenced duties that day and was ‘shadowing’ another member of staff. Another new staff was doing their induction with another member of staff. We spoke with one of the new staff. They told us they had a booklet to record their induction and had completed some training in moving and handling and health and safety. We saw evidence of staff induction on their personnel files. All of the people with spoke with made very positive comments about the staff. One person told us they always had the same person to support them with bathing. They said that they felt only two night staff was not sufficient. We asked them if their night needs were met. They said that they were. They told us that most of the staff knocked on their bedroom door before being invited to come in. Another person told us “you’ve only got to ask and they get it for you”. In survey forms people were asked about whether staff listen and act on what they say. One person said “no” and commented “not always - they forget to carry out instructions.” Another person commented “most of the staff listen but not all.” Another person wrote “not always usually too busy , they have an awful lot to do. Staff need to respond to call bells quicker. Some of the younger staff not experienced enough to deal with some situations i.e. falls and medical emergencys. All staff work really hard and are always pleasant. A very nice home”. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 28 In survey forms staff were asked whether their induction covered everything they needed to know about their job. Three staff said that induction covered their role “very well” and two said “mostly”. One staff said “it was a little hurried in places although the staff explained things if I did not understand them.” Other comments included: “get someone in to interact more i.e. activities with service users or put more staff on duty”, “need more moving and handling equipment” and “we care for the residents well”. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 29 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management team have a supportive open approach to running the home. There is little forward planning for developing and improving the service. Staff do not benefit from regular supervision. Health and safety and maintenance issues are not addressed as they arise. EVIDENCE: Mrs Merry and the deputy manager both have NVQ Level 4. Mrs Merry has the Registered Managers Award. Mrs Merry is a qualified trainer and provides some of the in-house training. She told us she had recently attended a conference on dementia care with a nationally recognised speaker in this field. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 30 She showed us the literature and books she had purchased. Mrs Merry told us that staff training would be provided using this resource. We remain concerned that very little is done to address the requirements we have made at previous inspections. In surveys staff were asked whether their manager meets with them to give support and discuss how they are working. Two staff answered “regularly”, one said “often” and two said “sometimes”. We asked some staff whether they had regular supervision. Some staff had had supervision but not for some time. We saw in staff records that supervision had been carried out fairly regularly until April 2008. Staff told us that they would air their views at staff meetings, which were held every 3 or 4 months. They told us that they did not have one to one time with a senior member of staff. We advised that staff must receive regular supervision to discuss all aspects of their practice, the home’s philosophy of care and their development needs. In the AQAA Mrs Merry told us that a quality assurance programme had been purchased. This included policies and procedures that staff were in the process of reading. The AQAA stated that quality assurance was being started. Action has been taken to address the requirement we made that all chemicals used in the home are stored securely. This is to prevent people who use the service from being at risk of injury. We did not see any chemicals on our tour of the building. Mrs Merry told us that all cleaning products were now locked away in an upstairs cupboard. We saw the home’s current insurance document displayed. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 31 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 1 X 3 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 3 Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 32 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16(n) Requirement The person registered must consult with people who use the service so that they can be involved in a programme of meaningful and appropriate activities. (Outstanding for the last 4 inspections. Mrs Merry reported that a post for activities co-ordinator was being advertised). Timescale for action 01/09/08 2. OP19 23 31/10/08 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. Refer to this standard for details on issues identified. (Outstanding for last 4 inspections. However some progress is being made in some of the bedrooms and corridors). The carpet with rucks in it must be re-laid or replaced. The registered person must add the additions to their Statement of Purpose and Service Users Guide as described in this standard and send a copy to the DS0000016402.V369185.R01.S.doc 3. OP1 6 04/09/08 Chaxhill Hall Version 5.2 Page 33 Commission. (Outstanding from the last three inspections. Mrs Merry said she had supplied copies of the documents. However those given at the inspection were out of date). 4. OP2 5(1bc&bd) The registered person must update their Service Users Guide to include the information in relation to fees as described in this Regulation. This is to ensure that people who use the service have all the information about the service available to them. (Outstanding from the last inspection). 15 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. (In some progress) The registered person must ensure the home’s adult protection policy is updated with the latest legislation. (Outstanding from last three inspections. Mrs Merry could not find the policy). 04/09/08 5. OP7 04/09/08 6. OP18 13(6) 04/09/08 7 OP36 OP10 18(2)(a) 8 OP8 13(4)(c) The person registered must 30/09/08 ensure that all staff receive regular supervision. They should be encouraged to look at improving their care practice, communication with people who use the service and training needs. The person registered must 04/09/08 ensure that people’s risk of DS0000016402.V369185.R01.S.doc Version 5.2 Page 34 Chaxhill Hall 9 OP9 13(2) 10 OP9 13(2) 11 OP37 17(1)(a) 12 OP38 12(3) & 13(4)(c) 13 OP19 23(4)(a) 14 15 OP26 OP38 23(2)(d) 13(4)(a)& (c) developing pressure damage is regularly assessed as before using the newly obtained tool. The person registered must ensure that confidential medication administration records and prescription information are always kept securely. The person registered must ensure that regular audits of the medication are carried out to ensure there are no discrepancies or errors. The person registered must ensure that the immediate care charts with regard to food, fluids and moving people, accurately record staff’s interventions. The charts should identify what is to be achieved at different times of the day. The person registered must ensure that decisions and agreements for the use of bed rails are fully recorded in care plans and risk assessments. The person registered must ensure fire safety in all parts of the building. Pieces of wood must not used to hold doors open. If doors are needed to be held open for any reason, then an automatic self-closing device must be fitted so that doors close automatically in the event of the fire alarm being sounded. The person registered must ensure that all parts of the home are kept clean. The person registered must continue with the programme of guarding radiators so that people are not at risk of scalding if they should fall against the hot surface. 04/08/08 04/08/08 04/08/08 04/08/08 04/08/08 04/08/08 01/10/08 Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations The home should have a programme of redecoration in place to improve the environment for service users. (In good progress). The home should check window restrictors to ensure they are the correct width to reduce the risk of people falling out of the windows. (Two unrestricted windows were fitted with devices during the inspection). The home should devise a training matrix. (Outstanding from last inspection). The home should ensure that all the required maintenance and checks by contractors are up to date. (In good progress). The home should include in the person’s care plan for self -medication of a ‘prn’ medication, to be taken only when required, why they need to take this. The record should also state what prompts an administration. The staff in the home should consider attending the ‘Alerters’ training provided by the local Council and the Registered Manager the enhanced training. (Mrs Merry reported that this was no longer available.) An alternative should be sought. Whilst it is not staff’s responsibility to make a referral, they should be aware of the local procedure. The home should register with the Skills for Care. (Mrs Merry told us that this was achieved. However the home does not have access to the internet to access any information). Where people have communication tools, they should be DS0000016402.V369185.R01.S.doc Version 5.2 Page 36 2. OP19 3. 4. OP30 OP38 5. OP9 6. OP18 7. OP30 8 OP10 Chaxhill Hall 9 10 OP10 OP37 OP8 11 12 13 14 15 OP9 OP37 OP9 OP9 OP4 OP3 used so that people can engage with others and know what is happening during the day. People who use the service should not be left in wheelchairs. They should be offered chairs in the sitting room or at the dining room table. Immediate care charts should identify what input is to be achieved each day, for example, time of turning people at risk of developing pressure damage and how much fluid should be given. Handwritten entries in the medication administration record should be witnessed, signed and dated by two staff. Staff should avoid handling medication in order to stop any contamination. Records should be kept of all unused and unwanted medication at the time that it becomes unwanted. Consideration should be given whether the home’s current categories of registration are varied to include dementia Consideration should be given to more focus on people’s social histories and what activities they like to be involved in when assessing their needs before admission. Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chaxhill Hall DS0000016402.V369185.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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