Inspection on 26/10/06 for Chelfham House

This inspection was carried out on 26th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Chelfham House 05/04/07

Chelfham House 21/12/05

Chelfham House 09/08/05

Chelfham House 22/02/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Chelfham House Chelfham House Chelfham Barnstaple Devon EX31 4RP Lead Inspector Victoria Stewart Key Unannounced Inspection 09:30 26 and 30th October 2006 th 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 Chelfham House DS0000062357.V306974.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. Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chelfham House Address Chelfham House Chelfham Barnstaple Devon EX31 4RP 01271 850373 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) Mr Mark James Hammond Mrs Karen Jane Hammond Mrs Wendy Margaret Plant Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (28), Old age, not falling within any other category (28), Physical disability over 65 years of age (28), Sensory Impairment over 65 years of age (28) Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st December 2005 Brief Description of the Service: Chelfham House is a privately owned care home registered to provide care for up to 28 residents over 65 years of age. The home’s service is for people whose needs may relate to old age, a dementia-related illness, a mental disorder, a physical disability or a sensory impairment. The home is situated in a small rural hamlet, on the outskirts of Barnstaple in North Devon. The two storey detached property stands in its own large grounds, with commanding countryside views from many aspects of the building. The home was not purpose built as a care home, but has been adapted over the years to meet the needs of service users to provide 22 single bedrooms and 2 double rooms (of which a total of 17 have en-suite facilities). There is a newer ground floor extension, which was completed in 2000, with work currently going on to build a single-storey extension to provide a further 10 resident rooms. There is a passenger lift to all floors and a call bell system is installed throughout the home. The cost of care at the time of the inspection was in the range of £299-385 although a fee increase was expected. Chiropody, hairdressing, personal toiletry items and newspapers/magazines are additional costs which are not included in the fees. Residents are also charged an additional cost if they require transport to appointments and a further charge if a member of staff is required to escort them. The latest CSCI inspection report is not displayed in the home but is available upon request. Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as part of the planned inspection programme for the year 2006/7 and took fourteen hours over two days. The actual inspection date was unannounced but the home had received prior notification that an inspection would take place within three months. The home had 28 residents living at the home when the inspection commenced. During the visit the inspector specifically looked at the care given to four selected residents with different care needs and spoke at length to seven residents. The remaining residents living at the home were either seen or spoken with briefly. As the home provides care for people with a dementiarelated illness, a number of the residents do not have the capacity to communicate fully or understand the inspection process. A considerable amount of time was spent observing the care and attention given to these residents by staff. Prior to the inspection a number of CSCI questionnaires were sent out. Ten were sent to residents and five were returned. Many residents were unable to complete these due to their communication difficulties and of those questionnaires returned, staff working at the home had helped residents to fill these in. Five questionnaires were sent to relatives and three were returned. Relatives of four residents were spoken with during the inspection and a further relative spoke with the inspector by telephone. Three questionnaires were sent to health or social care professionals and one was returned. Two healthcare professionals were spoken with during the inspection and a further professional spoke with the inspector by telephone and forwarded a written report. Eleven questionnaires were sent to members of staff and seven were returned. Nine members of staff were spoken with at length during the inspection, including the manager, senior staff, plus staff from the care, housekeeping and kitchen teams. Additional information was gained from the pre-inspection questionnaire completed by the home prior to the inspection, by undertaking a tour of the home, by looking at a selection of records (including residents’ files, medication records, staff files/training records, quality assurance records, health and safety records) and by sampling the lunchtime meal. The outcome of the inspection was discussed and agreed with the owner, registered manager and a senior member of care staff before the inspector left Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 6 the premises. All parties are keen to work towards making the improvements necessary to ensure that all residents receive the care they need. What the service does well: What has improved since the last inspection? What they could do better: The home needs to ensure that all prospective residents have information about the service and facilities of the home given to them before they choose to live there. It would be good if there were more opportunity for prospective residents to visit the home before they moved in. Care plans and risk assessments need developing further to contain more information to assist staff to fully meet residents’ needs. Medication records need to be maintained properly and the home needs to ensure all medicines are stored in an appropriate manner. This will mean that residents’ safety is maintained. Some staff must think about the way in which the privacy and dignity of residents is met, so that at all times residents can be sure that they will be cared for in a respectful way. They also need to improve the way in which residents are given choices in their daily lives, especially for those residents who are unable to do so for themselves. The home needs to look at the way that activities happen so that all residents have equal opportunities to engage in meaningful and stimulating recreational interests. Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 7 Staff must ensure that mealtimes are a pleasant and enjoyable time for all residents living at the home and that residents are given suitable type, choices and quantities of food. The home must continue to be updated and modernised to make it a suitably and nicely furnished place to live in. The home needs to ensure that resident’s personal items of laundry are maintained and looked after. The management must ensure that suitable staffing levels are maintained at all times and that this is monitored and regularly reviewed according to the dependency levels of the residents. Staff who work at the home need to receive adequate training and supervision in their care practice to ensure that they know how to look after the residents properly. The home needs to address the problem of communication difficulties between some staff and residents to ensure their needs are fully met. The management organisation of the home needs improving to give suitable direction and guidance to all staff employed. Residents need to ensure that the correct manual handling techniques and equipment are used at all times. The home needs to ensure that all records relating to residents held in the home are kept up to date. 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. Chelfham House DS0000062357.V306974.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 Chelfham House DS0000062357.V306974.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not always have sufficient information about the home in order for them to make an informed decision about whether the service is right for them. There is a good assessment process at the home, meaning that residents can generally be assured that the home will be able to meet their needs. However, staff may not collectively have the skills and experience to deliver the service and care. EVIDENCE: The home has produced a comprehensive and useful statement of purpose (SOP) and service users guide (SUG). Both of these documents were looked at and contained lots of relevant and useful information regarding the service provided by the home. Of the five resident questionnaires returned, one resident agreed that they had had enough information given to them prior to moving into the home and one resident chose not to comment. The other Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 10 three residents commented that they had not received enough information about the home before they moved in and one commented that they had received “nothing at all”. One returned relative questionnaire also said that they had not been given enough information about the home and commented “a welcome pack containing staff names and care home details would be useful when relative/friend first comes into the care home, it saves asking for details, names etc.”. Three residents spoken with were asked if they had received copies of any information about the home and they said they did not remember having any. A copy of the SUG was not freely available in the home or individual copies held by residents in their private rooms. One resident spoken with, however, did confirm that she had “come for a look around” the home before she had moved in. Four resident files were looked at. All of these files contained suitable assessments carried out by a health and/or social care professional if available. The manager also visits all prospective residents and carries out a further preadmission assessment when she obtains the initial information required to see whether the home can meet the prospective resident’s needs or not. These completed assessments were seen in the residents’ files. The home has residents living there who may have a variety of care needs ranging from old age to dementia, mental disorders, sensory impairment or a physical disability (for people over the age of 65 years). There is a core of staff who have worked at the home for several years but the majority of the workforce are relatively new in post. Some of the staff have had the training necessary to look after the diverse needs of all of the residents, but some lacked the basic knowledge, skills and experience to be able to fully meet residents assessed needs. Chelfham House DS0000062357.V306974.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 at least once during a 12 month period. 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. Although improving, the planning and delivery of care is variable which means that all residents cannot be sure that their personal care needs will be fully met. Possible risks to residents are not always identified and could therefore cause unnecessary harm to residents. There are some good systems for managing medication, but other areas of poor practice may affect resident safety. Residents are not fully treated with the privacy and dignity they should be. EVIDENCE: All of the residents’ questionnaires confirmed that they “always” receive the care and medical support they need with one comment of “yes, very much” given. Both of the relatives questionnaires received said that they were Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 12 satisfied with the overall care provided. Three further residents commented to the inspector that they felt their care needs were met. Two care professionals visiting on the days of inspection were spoken with; one questionnaire and one report were also received from a care professional. All said that there was good communication and working between them and the home. However, comments were received that concerns had been raised that they felt the care given in the home had begun to generally deteriorate and was not as good as it used to be. The care planning records and risk assessments of four residents were looked at. While the care records contained some good information, for example the “life story” of residents, other necessary information was missing, for example that relating to wound care and falls. One file had recorded that the resident had recently fallen but this had not been written in the accident book nor followed up. Care plans outlined the resident’s general care needs and tasks to be performed by staff, but not enough information was written about how staff should actually ‘care’ for the residents. For example one resident had a catheter and the care plan stated that staff should give “catheter care”. However, there was no detail or other information available to staff about what catheter care was and how they should do this in relation to this particular resident. Another care plan looked at said that a resident had “mobility” problems but no information or detail provided about how staff should assist this resident and what aids/adaptations were used to help/assist them maintain their safety and independence. One resident told the inspector that she was has recently been “forced” into having a bath on a certain day by care staff. She complained to the manager and this resident now has a choice of whether to have a bath or not. It was felt that the problem had arisen due to lack of understanding and communication problems. Risk assessments were seen completed in some files relating to manual handling but behavioural and situational risks had not been assessed and planned for. For example, one resident using an electric wheelchair had sustained a very bad wound on her lower leg from accidentally banging into her metal bed sides and another resident suffering from dementia was seen wandering into the kitchen and seen handling kitchen utensils. One female resident told the inspector that one male resident wanders into her bedroom and bangs on her door at night. No strategies had been outlined for managing these situations and they had not been risk assessed to ensure that any hazards were minimised. This puts residents at risk. The manager draws up all the care plans herself with minimal input from the rest of the staff. Staff write in daily care records but the manager said that unless a resident’s care needs immediately changed, then care plans were left for her to complete. The manager said it was very difficult to keep the records Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 13 and risk assessments up to date as she had very little time to do this as she was generally working as part of the care team with very limited administration time (see NMS 31). On the day of inspection one of the residents was very ill and being nursed in bed with hourly care being given. Whilst some charts and records were being recorded in the resident’s bedroom, the care plan had not been reviewed to fully take account of this increase in care needs. Staff did not transport residents properly in their wheelchairs, for example residents were seen with their feet not on the footplates. One resident caught her foot on the floor underneath the wheelchair and the inspector had to point this out to the member of care staff immediately to prevent an unnecessary injury occurring. Care professionals have expressed their concern that wheelchairs are not being used in the home properly and that currently there are several skin injuries, of which one is severe, to residents where wheelchairs have been involved. Residents’ weights are monitored regularly. One resident had been put on a diet but the care records were lacking in detail about what had been agreed as a diet. Kitchen staff were also unaware of what diet this person was on meaning that dietary needs might not be met in the best way. Specialist nutritional advice had not been sought either, despite the resident saying they were ‘always hungry’. Some of the staff working at the home did not appear to have a good understanding of people’s needs (see NMS 27) and the lack of consistent information is affecting the continuity of care when relying on individual staff knowledge. Poor attention to detail in the care of the residents was noted, for example residents had not had their teeth cleaned, hair had not been brushed and residents were dressed in dirty clothes. One relative said that staff forget to put residents teeth in and give them meals that require chewing. Residents were also seen to be left sat in their wheelchairs in their private rooms for unnecessary long periods of time whilst waiting for staff, who had gone to do other jobs, to return to take them to the communal areas. The management of medication was looked at. Staff who are appropriately trained in the administration of medication dispense medicines. The Medication Administration Record (MAR) chart was looked at. Whilst this was generally completed satisfactorily, there were some errors in the way that medication had been recorded. For example, some medicines had been crossed off the chart for no apparent reason, unsigned and dated, and then restarted on another chart. Also when medicines have been added at short notice, for example antibiotics, these had not been signed or recorded properly. The home does have some controlled drugs and these were checked and matched with the records. The practice of breaking tablets into two pieces (halving the dose) prior to administration should cease. The home was using a portableChelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 14 type fridge to store some liquid medicines in. This storage is inappropriate due to the liquids not needing to be kept refrigerated. However, if any medicines do require refrigeration, then an appropriate fridge should be used that can regulate its temperature constantly. During the inspection, staff were seen to knock before they entered residents’ private rooms. However, residents, relatives and care professionals commented that this practice is not normally used and staff enter private rooms without knocking. The home has two shared rooms. The curtain screen dividing one of the rooms does not offer full privacy (due to its shortness) from the other occupant and these curtains were falling off the rails. Two residents commented that clothes had gone missing in the home and two relatives commented that new items bought for their relative had also gone missing, for example seven vests and a new jumper. One relative saw, on one occasion, that another resident was seen wearing a jumper of her mother’s. Some residents clothing needed attention, for example one gentleman had a button missing off his trousers so they could not fasten up and were falling down. Several female residents had inappropriate facial hair which showed a lack of dignity. Not all of the toilets and bathrooms in the home have adequate locking devices and residents could easily be disturbed. One resident returning from the toilet accompanied with a member of staff looked dishevelled and not dressed properly; her cardigan was tucked in her skirt and her skirt was not fully pulled down. During the lunchtime meal, one resident was seen to be being fed whilst asleep, almost laid down and with her eyes shut, which made the mealtime event for this particular resident undignified and inappropriate. During the inspection one resident was seen to be sitting on the entrance hall steps for some time exposed before staff saw that she was partly undressed and had removed her incontinence aid. Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A limited range of activities within the home and community mean that residents do not have a wide range of stimulating and motivating activities. The home provides a welcoming and friendly approach to relatives and visitors. Several residents could be more empowered to make daily choices and retain some control over their lives. A balanced diet is provided but aspects of provision, choice, variety and delivery need improvement to ensure that meals and mealtimes are a pleasant experience for all residents. EVIDENCE: All five of the resident questionnaires said that there were activities they could take part in, which are exercises, singing and bingo. Two commented that “I am always asked but I prefer my own company” and “I don’t always want to do them”. Currently the home does not have anyone taking responsibility for resident activities and staff take it in turns to undertake activities for one hour between 2pm - 3pm daily. There is a record of activities undertaken which Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 16 showed that not much thought or structure goes into planning these and none were seen on the day of inspection. One lady is taken out shopping on a weekly basis but this activity is not offered to others. Three staff members spoken with said that they would like to see more activities introduced and that they would like them to be more “stimulating” and “challenging” for residents. They would like to be able to take residents on trips out. Some resident care records had a ‘life story’ within which was stated what occupation they used to do and the hobbies they used to have. However, this information is not currently being used to plan activities. During the inspection, several residents spent varying periods of time unoccupied with little social contact from staff unless receiving direct care. Relatives confirmed in their questionnaires and when spoken with that they are always made to feel welcome at the home and that the atmosphere is friendly. One described it as “brilliant – like a little family” and another said “even though it’s run down, staff are warm, friendly, helpful and cheerful”. Choices relating to individual residents were not recorded, for example what time they like to get up or go to bed, or how they like to spend their day. There is a lack of food choice available for residents and at coffee/tea times, staff handed biscuits to residents rather than letting them choose themselves. In a recent resident meeting some residents expressed a choice for introducing a fried breakfast on occasions and having more of a choice of breakfast cereal and biscuits. Mixed comments were received from residents regarding the meals served at the home. All of the questionnaires sent to residents confirmed that they “always”, “usually” or “sometimes” liked the food and one resident commented, “the food is grand”. However, of the seven residents spoken with on the day of inspection, all of them thought the food could be improved upon. All of the residents did not know what they were having for the lunchtime meal on the days of inspection and felt they did not have enough choice about food. One resident said “we have what is given” and felt that the food especially served at teatime needs improving as it is unappetising. Other resident comments included “I don’t know what’s for lunch. It’s wait and see – if I don’t like it I have to eat it”, “I don’t know what I’m having until they bring it – got to guess and got to have a sense of humour” and “I get whatever they fling at me”. All of the residents said that if they did not like the meal, then no alternative was offered and that it was difficult to get the care staff to understand that they would like something else. This practice results in the residents not having anything else to eat. There is a procedure in place for residents choosing their meals on a weekly basis and this was seen. However on the days of inspection, this information had not been passed to the kitchen and therefore residents’ choices were not being taken into account. The kitchen stores, fridges and freezers were looked at and were adequately stocked. Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 17 The cook reviews the meal planning with the manager and has not worked at the home for very long and is still settling. She is eager to make improvements in the kitchen and the food served. The kitchen had two menus for individual residents displayed on the wall. Food, fridge and freezer temperatures are not being routinely monitored and the relief cook on the first day of inspection said “I don’t do temperatures” but that other staff might. Staff felt that the food is not as good as it used to be and one resident expressed their preference for one member of staff doing the cooking. On the regular cooks days off, various staff fill in and therefore there is no continuity. The inspector saw breakfast and lunchtime meals being served. On the first day of inspection, breakfast was still being served after 11 am and lunch was then served at 12 pm. The cook said that there was no official cut-off for breakfast and that residents often had their breakfast this late. Breakfast time on both days of inspection appeared very disorganised with residents being left in the dining room whilst care staff went to care for other residents. Some residents were left with their breakfasts to go cold until they were given assistance by staff and some cereal, such as weetabix, was seen to need reheating as it was cold. One resident who asked for cornflakes for breakfast was denied them and told “just have to have weetabix today”. The inspector shared lunch with seven residents. Lunch consisted of Cornish pasty, mashed potatoes and swede with rhubarb crumble and custard for dessert. Whilst the food was satisfactory, it was served on side plates with small portions. The plates proved difficult for residents to use as they are too small and some residents do not have the finer skills to prevent food falling off the plate. There was a long gap in between the main course and the dessert with residents getting bored and starting to leave the table. When the dessert was eventually served, it was far too hot for residents to eat and could possibly have burned their mouths if they had tried to eat it. Residents had to wait until it had cooled down. Food served to those residents who had a ‘soft’ diet was extremely unappetising and consisted of all the food pureed together to make a pale runny soup. The inspector felt that some of these residents could have eaten a diet which had been cut into small pieces rather than fully liquidised. One resident was seen being fed inappropriately in a chair (see NMS 7). Some residents commented that they would like to have some food served for supper as sometimes they are hungry as tea is served at 4.30 pm and they are offered only a biscuit later in the evening. Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 18 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 inspected at least once during a 12 month period. 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. Although residents are confident that they will be listened to and that their interests will be actioned, the complaints process does not ensure consistency in its approach. Most of the staff have a good understanding of what to do to protect residents from abuse, however additional guidance, training and supervision will protect residents further. EVIDENCE: Out of the five resident questionnaires, two said they knew how to make a complaint, two said they did not know how to complain and one said they “usually” know how to make a complaint. There have been several different complaints since the last inspection, including those received by the home, by the CSCI or by health/social care professionals. These related to various standards including lack of answering/monitoring call bells during the night, care practice, staff not answering call bells, lack of cleanliness of the home, coldness of the home, staffing issues, health and safety and missing laundry. Some of these complaints have been investigated satisfactorily and the appropriate action taken by the home. Some were upheld and some not. However, the inspector felt that with at least two of the complaints (relating to poor care practice), the home did not take the most appropriate action to safeguard the residents at the home. Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 19 Staff responding to CSCI questionnaires demonstrated an awareness of policies and procedures to protect residents from harm. Some staff questioned understood what to do if they suspected that residents were at risk from harm, and training on the Protection of Vulnerable Adults was scheduled to take place the day following the inspection. The inspector felt that residents could be placed at unnecessary risk by staff resulting from their lack of knowledge of dementia, skills, experience and supervision. Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some improvements to the general environment have been made. However, this needs to continue to provide residents with a clean, safe, comfortable and homely place to live in. Current laundry arrangements are not fully suitable and infection control procedures need improving to ensure resident and staff safety. EVIDENCE: Since the last inspection, the home has continued to improve with three rooms re-decorated and some new carpets and a television installed to make the home better for residents to live in. Mixed comments were received about the cleanliness of the home. All five of the resident questionnaires said that they felt the home was “always” fresh and clean. However, all of the relatives and the majority of the residents spoken with felt that the home was “run down”, with “a lack of cleanliness in private rooms and the home”. One relative Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 21 commented that private rooms are not cleaned properly and that food is left in waste bins for several days before being emptied. Also that the private rooms are not cleaned thoroughly, for example the beds are never pulled out, the furniture is dirty and carpets are not cleaned regularly. Two bedrooms were looked at and they were in need of cleaning, for example one bedside cabinet was extremely dirty with drink stains on the top and in the drawer. Also several rooms had problems with the curtains, for example the curtains in one room had not been up for some time and other residents had curtains that were hanging off. The communal areas and stairs were generally clean and tidy. The manager and provider acknowledged that there have been problems with the level of cleanliness in the home and records showing this were seen. Some areas of the home were cold, especially one shared room on the first floor. Other records in the home also showed that this issue had been raised before and one resident was seen putting a coat on another resident because they were both cold. Residents are able to personalise their own rooms and items of sentimental and personal value were seen in private rooms, for example pictures, photographs and furniture. Several of the residents said that they liked to stay in their own rooms with their meals served there. On the days of inspection, the home did have some offensive odours in two of the private rooms and this was discussed with the management. There is currently a 10-bedded extension which is being built on to the side of the home. As a result, the garden area is not very appealing to residents at the moment due to equipment, work vans and a large metal container. One of the residents showed the inspector her room and as a result of the extension, she no longer has a view from her window at all. A slated roof, which completely blocks the window, now directly covers this and as a result the room is very dark and she needs her light on during the day. The inspector was told that this resident would be having a new room in the extension when it opens and the resident accepts this although would have preferred not to move rooms. Relatives said that work seemed to be taking a long time and this was causing some inconvenience, for example one resident had to look at scaffolding from the window of their private room. The home has a laundry room and equipment includes one commercial washer and two domestic dryers. Staff felt that the residents would benefit from another domestic washer to clean their woollens and items which need a gentle wash. The commercial washer is full most of the time with bedding and therefore washing is not getting back to residents as quick as it should. Staff, residents and relatives also said that there have been problems with the laundry process with items of clothing being lost or misplaced, despite being labelled. There are not hand washing or sluicing facilities directly in the Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 22 laundry room although a sink is sited in an adjacent WC for staff to use for washing their hands. The inspector saw the procedure for taking dirty and contaminated laundry from the private rooms to the laundry room for washing and felt that this was unhygienic and unsatisfactory for both the staff and the residents living in the home. This was discussed with the management and owner. The home has a passenger lift which gives residents access to all areas of the home. Currently the kitchen store, which houses the dried foods, has inappropriate equipment stored in there, for example zimmer frames and incontinence aids and this should be addressed. The inspector saw that aprons and gloves were being used on the day of inspection, but felt that they were not readily available and accessible for staff to routinely use as staff were seen constantly asking for them. Professionals visiting the home and some residents commented that staff do not routinely use gloves and aprons and the practice of wearing them was unusual. Chelfham House DS0000062357.V306974.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 at least once during a 12 month period. 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. Residents are protected by the homes satisfactory recruitment procedure. Although actual staffing numbers are generally sufficient to ensure that residents general care needs can be met, the deployment and ways in which staff work need addressing and reviewing. The home needs to constantly monitor and review its staffing levels according to the dependency levels of the residents at the home. Staff have not fully received the training necessary to ensure they can meet the specialist needs of the residents living at the home. EVIDENCE: Mixed comments were received from residents. Completed questionnaires said that staff were “always” or “usually” available when needed. However, on the day of inspection, all residents spoken with said that staff were not always available. Comments from six different residents included “it’s hard to find somebody”, “if you want something, it can be a long time”, “I ring my bell and they just don’t come – they ignore it”, “staff are so busy and don’t understand me”, “I wish staff had more time for us” and “there is not enough staff to help”. One other resident spoken with said that her call bell did not work and that she “had to bang on the floor with her foot” but nobody heard her. This Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 24 lady was sat in a chair and her call bell is fixed above her bed at the other side of the room and therefore could not summon help. Residents also said that when call bells are answered, sometimes staff couldn’t understand what the resident needs. This was discussed with the manager and owner. There were some communication problems between some staff and residents and several residents commented that this was a problem. They said “the staff are kind but it’s hard to understand and they speak very fast”, “I am unable to understand”, “there is a language barrier”, “we have a lot of foreign staff and I can’t understand them” and “if I want something, I have to wait for someone else and it can be a long time”. During the inspection, the call bell was seen ringing and on two occasions, due to the long length of time to answer the call went into emergency mode. When this happened, staff were observed to be continuing to make beds and not responding to the call system. Care professionals commented that it is sometimes difficult to find someone senior to speak to with staff “running around”, with the home giving the appearance of being short-staffed. Staff commented in their questionnaires and when spoken with that they felt that the home was short-staffed on occasions but that the staff all worked as a supportive and hard working team. The inspector noted that during the day there were periods when residents in the ground floor lounge and dining rooms were unsupervised for long periods of time. Three staff files were selected and looked at. These all contained all the information necessary to protect residents from unnecessary risk. However, the application form used is outdated and would benefit from having more information included in it. The home regularly holds training sessions for staff which have included infection control, dementia, manual handling, fire, first-aid and medication. However, the inspector felt that despite being offered and attending the organised training, some staff might not have actually found them beneficial due to communication problems. It was unclear from records how many care staff have a formal qualification in care (NVQs). The majority of staff responding in surveys said they were not asked to care for people with needs outside of their experience. However two staff surveys said they had been asked to do this and one other said they had been asked in the in the past but not recently. Staff members spoken with said that not all the staff in the home used the correct manual handling techniques and procedures. Care professionals also voiced concerns that the appropriate equipment is not being used and on the days of inspection, the inspector did not see any moving aids being used. Chelfham House DS0000062357.V306974.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents, relatives and staff benefit from a friendly, open and homely atmosphere. The management organisation of the home needs improving to make sure that staff have clear leadership, guidance and supervision. This will mean that residents receive quality care in a safe environment. There is some evidence that the homes involves residents in the running of the home and their views are sought. Some practices in the home do not promote the health, safety and welfare for residents and staff and may cause unnecessary risk. Whilst some records held in the home are adequate, improvements in others would mean that residents are fully safeguarded. Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager is appropriately qualified and experienced in a caring role. However, she is relatively new to the role of registered manager and has not worked in any other care establishment. All staff questionnaires and interviews indicated that she was “friendly”, “approachable”, “supportive” and “willing to lend a hand”. No deputy manager is employed but there are senior care assistants. There were mixed staff views on the provider’s commitment to the home, with some feeling that he was “approachable” and “helpful”, whilst others felt that “he has no idea about care” and “I cannot approach him with any ideas”. The owner visits the home three days every week but staff felt that his actual presence in the home was very limited to doing administration and paperwork rather than speaking with residents. The home is developing systems for reviewing the quality of the service offered and questionnaires have been sent out to residents/relatives which were seen. Regular staff meetings are not held and most staff felt these would prove useful if they were. Resident meetings are held from time to time and specific topics discussed, for example food. The home encourages relatives to assist residents to manage their finances. The home is just in the process of setting up one resident bank account and has agreed to manage this on behalf of the resident. The majority of staff questionnaires commented that they received formal and informal supervision. However, staff working night duty, in the kitchen and the laundry areas did not have supervision and one member of staff commented that she had worked for several years at the home and did not need supervision. The manager felt that more observational supervision would allow her to identify where staff may need support to do their jobs properly but was unable to do this regularly due to her lack of management time. The manager has one hour daily to perform her management duties and does not work the afternoon or evening shifts. There was a general lack of management organisation, ownership and leadership in the home and this is in some part due to the limited hours worked and the lack of any supernumerary time from actual caring for residents. The manager does some work for the home in her free time, for example assessments on prospective residents as she is unable to do this within her paid hours of employment. Care professionals commented that there is a lack of management direction in the home, “particularly after lunchtime”. Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 27 General health and safety was managed well, fire safety records were looked at and found to be satisfactory and staff have received recent professional training. Records showed that maintenance of equipment and other systems are maintained. Poor manual handling techniques were seen on occasion which puts both staff and residents at risk (see NMS 30). Some other records held in the home were not complete and these are described under the individual standards. Chelfham House DS0000062357.V306974.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 2 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 2 2 Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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 13 (4) 1 Requirement Timescale for action 30/12/06 2. OP9 13 (2) The registered person shall ensure that unnecessary risks to the health and safety of residents are identified and so far as possible eliminated. With regard to: • Ensuring that risk assessments must identify behavioural, situational and environmental risks. The registered person shall make 30/12/06 arrangements for the safe recording and administration of medication in the care home. With regard to: • Ensuring that the home must appropriately record any hand written entries on the Medication Administration Record (MAR) Charts - this entry is then signed, dated and double-checked. • Ensuring that only the necessary medication is kept refrigerated • Ensuring that any medicines that need to be kept refrigerated are maintained at a constant DS0000062357.V306974.R01.S.doc Version 5.2 Chelfham House Page 30 3. OP10 12 (4) a 4. OP12 16 (2) m,n temperature of between 2o & 8oC. • Ensuring that no medication is crossed off the MAR chart without suitable authority gained and this entry is then signed, dated and doublechecked. • Ensuring that tablets are not broken into two (to half the dose) until the time that they are required and this is then appropriately recorded. The registered person shall make 30/12/06 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. With regard to: • Ensuring that residents living at the home must be treated with respect, privacy and dignity at all times. The registered person shall 31/01/07 having regard to the size of the care home and the number and needs of service users consult service users about their social interests and make arrangements to enable them to engage in local, social and community activities and consult service users about the programme of activities arranged by or on behalf of the care home. With regard to: • Ensuring that residents living in the home are consulted about the recreational and social activities they would like to take part in at the home. • Ensuring that a DS0000062357.V306974.R01.S.doc Version 5.2 Page 31 Chelfham House 5. OP15 16 (2) I, (4) 6. OP26 23 (2) d meaningful activities programme is drawn up which is suited to the individual residents living at the home, on a group or individual basis. • Ensuring that activities are arranged which offer stimulation and recreational interest to residents living at the home. The registered person shall 30/12/06 having regard to the size of the care home and the number and needs of service users provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may reasonably be required by service users. With regard to: • Ensuring that residents are served with appropriate portions of food on suitably sized crockery. • Ensuring that relatives are able to have alternative food offered if they do not like what is served. • Ensuring that food is available for residents if they are hungry. The registered person shall 31/01/07 having regard to the number and needs of the service users ensure that all part of the care home are kept clean and reasonably decorated. With regard to: • Ensuring that both the communal areas and the private rooms of the home are kept clean. • Ensuring that the home is free from offensive odours at all times. DS0000062357.V306974.R01.S.doc Version 5.2 Page 32 Chelfham House 7. OP37 17 (1) a Schedule 3 8. OP38 13 (5) The registered person shall 31/01/07 ensure that records held in the home are kept up to date. With regard to: • Ensuring that residents’ care plans, risk assessments and accident reports are reviewed and kept up to date. The registered person shall make 31/12/06 suitable arrangements to provide a safe system for moving and handling residents. With regard to: • Ensuring that all staff are adequately trained in moving and handling techniques and are using the correct equipment necessary to undertake the task. 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 OP1 Good Practice Recommendations The home should ensure that all prospective residents (and their relatives) considering living at the home, should have easy access to the statement of purpose and service user guide. It is recommended that all care plans and associated records contain more detail about what action to take to meet residents’ needs (for example, wound care, catheter care, falls, mobility and communication). It is recommended that staff training and supervision is available to ensure that residents’ privacy and dignity is maintained at all times. It is recommended that the home develops a strategy to ensure that choice and autonomy is developed and promoted for residents who are unable to make the DS0000062357.V306974.R01.S.doc Version 5.2 Page 33 2. OP7 3. 4. OP10 OP14 Chelfham House 5. OP15 6. 7. 8. OP18 OP18 OP19 9. OP26 10. 11. OP27 OP31 12. OP33 choices for themselves. It is recommended that staff ensure that the mealtime experience if a pleasant and enjoyable experience for all residents. That mealtimes need reviewing and hot drinks and snacks should be made available at all times and offered regularly and intervals between evening meals and breakfast be reviewed. That food that is pureed should be presented in a way that is attractive and appealing. That specialist advice should be sought when using special diets. That more choices of meals should be offered. It is recommended that training, guidance and support is given to all staff to prevent any abuse occurring through care negligence. It is recommended that the home review the level of staff supervision in communal areas to ensure the safety of residents. It is recommended that the environment continues to be upgraded to raise the overall standard of the home and that regular maintenance is carried out to carry out small repairs in the home. It is recommended that the home reviews the laundry equipment and updates the area. It is recommended that a strategy is developed to prevent residents’ laundry getting misplaced or lost. All staff need to follow infection control policies. It is recommended that staffing levels are monitored, reviewed and adjusted according to the individual dependency needs of the residents. It is recommended that the manager reviews her role in the home and receives an adequate amount of supernumerary time to undertake the necessary management tasks. It is recommended that all staff working in the home receive both informal and formal supervision. Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chelfham House DS0000062357.V306974.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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