Inspection on 05/04/07 for Chelfham House

This inspection was carried out on 5th April 2007.

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

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

Other inspections for this house

Chelfham House 26/10/06

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 Unannounced Inspection 5th April 2007 and 11th April 2007 09:15 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.V331281.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.V331281.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 01271 850814 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.V331281.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th October 2006 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 20 single bedrooms and 4 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 this time ranges from £314 to £400 per week depending on individual needs. Additional costs, not covered in the fees, include hairdressing, newspapers, toiletries, chiropody and some leisure trips. The home has recently submitted an application to the CSCI to increase the size of the home to allow a further ten people to live there. With this application, the categories of registration of the home may change if approved. Current information about the service, including CSCI reports, is available to prospective residents, relatives and others who may have an interest such as care managers. Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days – Thursday 5th and Wednesday 11th April 2007 and took eleven hours to complete. The home had been notified that an inspection would take place within three months and had returned a pre-inspection questionnaire, information from which has been used to write this report. At the previous key inspection carried out on 26th October 2006 a significant number of failings by the home were identified by the CSCI. A formal meeting was then held with between the CSCI, the owner and registered manager of the home, when positive, useful and helpful discussion took place to discuss the improvements necessary. This resulted in an improvement plan being drawn up and agreed between all parties. A random inspection was carried out on 30th January 2007 to monitor the progress of the improvement plan and look at the outcomes for residents living at the home. At that visit the owner and manager were working very hard to improve its service, but still acknowledged that there was a lot more to do. Since that date, the amount of time, effort and finance put into the home by the owner, manager and staff is commendable and has resulted in great improvements in the care practice, facilities and service for residents living at the home. Some other areas, however, still require further improvement and the home is committed to working towards rectifying these. There were 25 residents living at Chelfham House on the days of inspection and the inspectors either spoke with, or saw, all of the residents in the communal areas or in their private rooms. As a number of residents were unable to fully take part in the inspection process (due to communication difficulties), one inspector specifically looked at the wellbeing, engagement and staff interactions with these residents. One inspector spoke with six residents at length to gain their views on what it is like to live at Chelfham House. Those residents that were able to and several visiting relatives contributed to the inspection on the day, as did the owner, manager, deputy manager, cook, care and ancillary staff. Prior to the inspection, a number of CSCI information questionnaires were sent out by post to residents, relatives, health and social care professionals and care staff who work at the home to gain their personal and professional views about the home. Many comments made are included within this report. Eight questionnaires sent to residents were returned, six sent to relatives were returned, thirteen sent to health/social care professionals were returned and eleven sent to staff were returned. Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 6 This report is written using other evidence gained which included a full tour of the building and by looking at a selection of records relating to resident care, staff recruitment, medication, health and safety records and quality assurance. Feedback from this inspection was given, discussed and agreed with the owner, manager and inspector prior to leaving the home. What the service does well: What has improved since the last inspection? Requirements relating to medication practice, social activities, cleanliness of the home, staff recruitment, record keeping and health and safety have been fully met by the home. Requirements relating to privacy and dignity and staff training have been partially met but carried forward to this report. The home has made numerous improvements since the last inspection and should be complimented for their efforts. These briefly comprise of changes made to care planning, risk assessments, medication procedures, social activities, mealtimes, staffing levels, staff training, staff supervision, staff recruitment, general record keeping, general management, quality assurance, Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 7 the premises and health and safety. These are discussed in more detail within the report. What they could do better: 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. Chelfham House DS0000062357.V331281.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.V331281.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements in place to ensure that prospective residents have their needs fully assessed before moving into the home. This ensures that only residents whose needs can be fully met come to live at Chelfham. Prospective residents and their representatives are assured of a warm and welcoming approach when visiting the home. EVIDENCE: The care files of three residents were looked at including the resident who had most recently come to live at the home. All of these files had an appropriate assessment document, which had been completed before the resident had moved into Chelfham. The manager visits all prospective residents before they move into the home, either at hospital, their own home or another establishment to ensure that the home can meet all their needs. Any resident who cannot have their needs fully met by the care staff, facilities or services at Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 10 the home are now not accepted. This process has greatly improved since the last inspection and is now very structured. The home recently had one resident whose needs had deteriorated and staff felt that they could not longer care for this person properly. An assessment was requested by a social care professional and this person has now been transferred to a more suitable environment. Social care professionals placing residents at Chelfham were complimentary about the home and comments included “I have had no problems with this home in the last few years and have had full confidence in placing clients there”, “I believe that they have the right skills and experience or I would not place clients in the home” and “I moved a client there some time ago. Family are very pleased with the home, the client has settled well and they are coping with his/her behaviours”. All staff confirmed that they are now never asked to look after residents outside of their expertise. Relatives confirmed that staff at the home meet the residents’ differing needs and commented that “nothing is too much trouble” with staff having the appropriate skills and experience to look after residents. Trial visits are encouraged by the home. One relative confirmed that they had previously come to look at Chelfham without any appointment and that staff were kind, helpful and showed them around. This relative also said that staff had really helped their relative to settle into the home. Two other sets of relatives visited the home during the inspection to look at the possibility of their relative living there – these relatives were seen to be treated in a professional and helpful way by senior staff. Other relative/resident surveys said that they had received enough information about the home prior to moving in. The home does not provide intermediate care. Chelfham House DS0000062357.V331281.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good overall. This judgement has been made using available evidence including a visit to this service. There has been a significant improvement in the care planning process. Further development will enable staff to meet residents’ health and personal care needs in a consistent manner. The systems in place for the administration of medicines are good with clear and comprehensive arrangements being in place to ensure that residents’ medication needs are fully met. Residents’ benefit from a kind and caring staff group, but their privacy and dignity is not always respected. EVIDENCE: Three residents’ care files and risk assessments were looked at. These contained comprehensive care plans for each individual resident and had greatly improved since the last inspection. All three care plans contained lots of useful and necessary information but need developing further to deliver more ‘person-centred care’. For example entries in one care plan indicated that one resident might not want to get up early and that this might result in Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 12 the resident becoming aggressive or irritable. Care staff confirmed that if this happens, they deal with the aggression by asking for assistance from another carer. Good evidence of person-centred care was seen in one care plan that instructed staff on the important role a resident had held in the local community and staff confirmed they were aware of this. This same care plan reminded staff that this resident’s visitors were elderly and might need assistance with transport. With some help from the resident, relative and key worker the manager of the home is still formulating all care plans. When the manager feels happy with the concept of care planning herself, she intends to train the key workers to draw up care plans for their individual residents. This will enable care staff to be more involved with the care planning so that they are more fully aware of their care needs. Two social care professionals commented that the care planning has greatly improved and any help/advice given to the home by them was seen to have been welcomed and acted upon – for example the home now puts a summary of care need in the private rooms of residents to act as an aide-memoir to staff. One professional commented, “The care plans now revamped since the last inspection – look good”. Risk assessments have now been identified for each resident and are held in each file, but more work needs to be done to ensure that staff know how to deal with the identified risk and the correct way to manage it. For example, one care plan contained an assessment for the resident’s risk of falling, which showed a high risk identified. However, the care plan did not show staff how to manage this and staff confirmed they did this simply by “keeping an eye on the resident”. All returned residents’ questionnaires confirmed that they “always” or “usually” receive the care and medical support they need. However, residents were less positive about whether staff listen and act on what they say. Comments included “not always”, “sometimes”, “I have a problem understanding some of the carers. I also feel that I’m made to feel that I ring the bell too often”. These were discussed on the day. Mixed comments were received about the medical care given to residents. Residents confirmed they felt that they had all their medical care needs met, but health professionals commented that not all staff understood the needs of residents. This sometimes means that requests and advice given by them is not followed. Communication was highlighted as being a particular problem at times with certain members of staff. Half of the health professional replies were happy with the care given overall whilst half were not and felt improvements could be made. One resident living at the home is very frail and confirmed that she likes to spend all day in bed as it is more comfortable. The inspector felt that this resident was well cared for and she confirmed she was very happy. A summary Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 13 of care given, which was kept in her room, showed that staff had looked after her needs regularly. Care staff were indirectly observed treating her with gentleness and kindness at all times. Residents confirmed that staff maintain their privacy and dignity and stated examples such as knocking on doors and calling them by their preferred names. However, on the day of inspection, one resident having medical treatment given by a district nurse, was exposed to other residents, staff and visitors in the home. This was discussed with the manager. Comments from other health care professionals said that privacy and dignity is not always given to residents and that “the carers have to be reminded that patients will not be seen and treated in a public area” and that treatment is sometimes given in unsuitable areas, for example, in other people’s bedrooms. Screens were seen to be used in those rooms that are shared to promote privacy between residents. Staff were seen offering care and attention in a discreet and dignified manner. There were some lovely interactions seen between staff and residents and the relaxed way that residents were with staff was obviously demonstrating their contentment at the home. The medication procedures and records were looked at. The home uses a Monitored Dosage System (MDS) provided by a local Pharmacy. These have improved since the last inspection and are now regularly audited by the manager or the home – this ensures that staff manage, record and dispense all resident medication appropriately and any risk to residents is minimised. Any procedures/processes not followed correctly are discussed with the individual staff member and resolved. All records pertaining to medication were looked at and were found to be satisfactory. The home currently has no controlled drugs and no medication that needs refrigerating (although correct storage is available for both of these). Of those residents in the home who may be able to self medicate, they choose not to do so. Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have varied, well-balanced and nutritious meals, which are served in a pleasant and congenial way. Residents enjoy participating in a programme of social, leisure and recreational activities which are designed to fit the their individual needs. The home encourages family and friends to visit at any time and offers a welcoming approach at all times. EVIDENCE: Since the last inspection, the home has now recruited an extra member of staff as an activities organiser, who works 20 hours a week in the morning to improve the recreational activities for residents. Much improvement was seen since the last inspection and the inspectors saw that residents took part in a variety of tasks that were both suitable to their needs, stimulating and enjoyable. Part of the activities organiser’s role is to oversee and assist residents with breakfast whilst it is being served. This enables a member of staff to be always present during this time to offer assistance/help when required and enables residents to maintain independence and choice. The activities organiser has a real interest in providing suitable activities for the Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 15 residents and, as her role is relatively new, is currently exploring new opportunities for residents to take part in. Activities on offer now include one to one or group sessions. Arts and crafts, puzzles, games, flower arranging, basket weaving, bingo, jewellery making and reading are some of those on offer to residents. Outside activities planned for the future include a musical show, visiting pets and trips out. On the days of inspection, a visitor was judging an Easter Bonnet competition and residents were going to take part in a planned Easter egg hunt. Residents had enjoyed recent trips to the local garden centre and coast. Care staff also carries out some activities in an afternoon session between 2-4pm. One resident has had his particular passion in gardening fostered and on the day of inspection, the family were working with the owner and manager to put up a personal greenhouse, with the home then supplying this resident with some bedding plants. Other residents in the home take advantage of a ‘sensory’ trolley, which the activities organiser uses to stimulate those residents with a cognitive impairment such as dementia. This was seen to be providing much stimulation and enjoyment to those residents. A number of residents had enjoyed completing a scrapbook of their previous lives named “My Life” which had been completed with the help of relatives. These included lovely information about the resident’s previous life, interests and contained photographs of when they were younger. The home now intends to foster this further and make a continued scrapbook of the beginning of their new life after coming to live at Chelfham House. Residents confirmed that they “always” or “usually” take part in the activities on offer. Some residents choose not to be involved and commented “Not interested, I read my books, listen to my music and speak to my friend on the telephone” and “I don’t always want them I am ……… years old you know”. One resident commented “I would like to take part in more activities but I do not have a suitable chair to travel downstairs and sit comfortably”. Also some residents tend to stay in their rooms for most of the time. Ways of how to enable these residents be more involved in leisure activities were discussed. Those residents that are able confirmed that they have a choice in their lifestyle – for example one resident chooses to sleep in a reclining chair rather than a bed and one chooses to spend her day in bed, as it is more comfortable for her. Residents and their relatives confirmed in their questionnaires that they are made to feel welcome in the home at all times. Three relatives spoken with during the inspection confirmed this and comments such as “There is always happiness, laughter and plenty going on” and “Always a happy atmosphere, not just for the inspectors”. They also confirmed that no matter what time they visit, they are always made to feel welcome. Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 16 Residents commented that they “always”, “usually” or “sometimes” liked the meals that were offered. The way that meals are served, the type of food offered and the mealtime experience has greatly improved since the last inspection. Residents have a choice of main meal at lunchtime and choose the day before. A list of these choices is displayed in the kitchen. However, residents spoken with (with the exception of one) could not recall what was for lunch and commented that they were not routinely offered a choice of what they wanted. One commented that if she was given something she did not want, she just left the meal. Breakfast has now been completely re-organised, with those residents that are able, helping themselves to what and how much food they want to eat (supervised by the activities organiser) and taking as long as they wish. Staff commented that this is one of the most improved changes made for residents living at the home and one said “This has made a huge difference as residents can make choices for themselves and socialise more”. The way the lunchtime meal is served enables residents to choose what and how much they want to eat. Staff were clearly surprised sometimes by a resident’s choice, so checked these choices out discreetly and in a way and pace that suited the resident. Lunch was a really social occasion. Music, which residents clearly enjoyed and some sang along to, was played at a low volume. Staff were courteous and helpful in assisting those who needed it to help themselves with food. Residents who have friendships were assisted to sit together and when requests were made, no matter how strange they seemed, staff responded respectfully and helpfully. Residents had an appealing and nutritious meal on both days of the inspection, although on the second day the majority of residents were unable to chew the meat served and therefore did not eat it. Residents did enjoy the desserts served on both days. A variety of homemade cakes are made fresh daily for both the teatime meal and supper meals/snacks. The food store and kitchen were looked at. Both of these areas were clean, tidy and well organised. Records pertaining to the food served and the temperatures of fridge and freezers were routinely kept. The Environmental Health Officer had made a recent visit and advice offered by them had been taken up. Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. The home has a good complaints system and residents and relatives feel their views are listened to and acted upon. Residents are protected by staff who understand their duty to report poor practice. EVIDENCE: The home has an up to date complaints policy and currently records all complaints appropriately. Previous complaints had been investigated thoroughly and recorded and have now reduced in number. No complaints had either been received prior to, or during, the inspection. Residents and relatives confirmed in their questionnaires that they knew who to complain to and comments included “I am happy…I know I can speak to Wendy if I have a problem” and “Nothing to complain about – I love it here”. Staff commented in their questionnaires that they are aware of adult protection issues. Following the inspection the home provided evidence that staff are fully aware of adult protection issues. Staff have undertaken recent training in the Protection of Vulnerable Adults (PoVA) and are aware of the correct procedures to follow. They completed a questionnaire issued by the home, where they answered a range of questions correctly about what abuse Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 18 is, and what they should do if they suspect abuse is happening. Staff have also signed a list stating that they have read and understood all policies, procedures and POVA (Alerter’s Guidance). The manager and deputy manager will shortly be undertaking further PoVA training run by the Devon County Council Adult and Community Services. Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. The standard of the home is adequate and although this does not pose a risk to residents, some areas do not create a pleasing and pleasant environment to live in. EVIDENCE: Since the last inspection, the home has had some minor redecoration but the home continues to be in need of substantial refurbishment and redecoration in some areas. The owner is aware of this and has a plan of modernisation which will includes redecorating, supplying new fixtures and fittings and recarpetting. He has asked for advice about the building from a specialist in dementia care who is going to look around the building (inside and outside) and suggest what needs to be done to assist those residents with this illness for example, colour schemes, layout, signage etc. He then intends to decorate accordingly. The inspector was told that each private room would be completely refurnished when it becomes empty and this will provide residents with a suitable environment to live in. Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 20 Relatives commented in their questionnaires that they would like to see the home redecorated and updated. Comments included “Pleased to see major works being carried out on the new building which I am sure will be a great benefit to the residents”, “…likes her room despite the 1940’s furniture” and “perhaps day rooms modernised - some items well worn”. The home is currently in the process of having a brand new wing built which will provide a further ten rooms for prospective residents and will be furnished with completely new furnishings and fittings. Residents living at the home currently are being offered a choice of these rooms if desired. On the days of inspection, some visiting relatives were choosing one of the new rooms and were discussing with the owner and manager of Chelfham about how best to transfer their relative into the new wing, without causing too much unrest to him. Other residents confirmed they had been asked if they would like a room in the new wing, but most said they wanted to stay where they were. The home is sited in a beautiful and scenic area, with areas for residents to sit outside to enjoy the weather. Several residents went in and out of the home freely (but with the aid of staff) and enjoyed a walk around the grounds. The laundry area has one commercial washer and two dryers. Staff commented that they are managing residents’ laundry well at the moment, but when the new wing opens a new washer will be needed (which the owner is aware of and making enquiries into having one fitted). Residents’ clothing is now marked with their name and this has greatly reduced residents wearing other people’s clothes. Staff commented that this does sometimes happen still, but only very occasionally when clothing has no name on it. Relatives confirmed that this has improved. The home has purchased new trolleys to collect dirty linen throughout the home which lowers any infection risk to residents. Staff commented that they find these useful and that there is also a good supply of protective aprons and gloves for staff to use. The home was very clean throughout on the day of inspection. A part-time maintenance person has recently been employed who ensures that jobs around the home that need doing are carried out regularly, in communal and private rooms. Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to this service. Staff numbers throughout the day and night are sufficient to ensure that residents’ general care needs can be fully met. Staff receive the training necessary to do their jobs properly. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their quality of life. The recruitment procedures for the employment of staff are good and provide the safeguards to protect residents living at the home. EVIDENCE: The home operates a three-shift system from 7am-2pm, 2pm-9pm and 9pm7am. During the morning shift there are four carers, the activities organiser, two domestics, one laundry assistant, one cook and a kitchen assistant. On the afternoon shift there are four carers - these staff take responsibility for any cleaning or laundry that is needed to be done in the afternoon and serve the teatime meal and snacks. Two waking carers are employed on the night shift. Extra to this are the manager, who is supernumerary, and a deputy manager who leads the hands on care when on duty. In her absence, a senior care assistant undertakes this role. This ensures that there are enough staff on duty at any time to care for residents. Seven members of staff were spoken with to gain their views on what it is like to work at Chelfham House. All were very positive about the home and commented that it has improved in the last Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 22 year and was a nice place to work with high staff morale. This was confirmed in staff questionnaires. Residents and relatives were very complimentary of the staff at the home and comments such as “Staff are always friendly and willing to assist Mum when needed”, “… are the most caring and experienced, very kind” and “Look after their residents with great care and consideration – it is nice to know that she is looked after well and happy”. When asked what the home did well, comments were received such as “Care for people”, “Staff are all cheerful, welcoming and very kind” and “Their general care and attention to my wife and her needs and indeed their friendliness and kindness”. From the specific observations carried out by one inspector, all staff observed were kind and helpful. Some of the staff had a good understanding of personcentred care whilst others were at the beginning of their learning. For example, one member of staff kept trying to a sit a resident down who was trying to move away from their lunch and the resident then became irritated. Another member of staff helped the resident to move, checked how much they had eaten, checked that the resident did not want to go to the toilet and the resident then happily went on their way. The inspector observed an equal number of good staff/resident interactions (where the carer related to the resident in a positive way) and poor interactions (where the carer related to the resident in way that did not pay full respect to the resident as a person). The inspector felt that these interactions were not unkind in any way, but in fact were more aimed at ensuring the resident was safe and had had enough to eat and drink. Some staff were over helpful, for example two residents in different areas of the home were being fed by carers. These residents did not need so much help and more could have been done to ensure that these residents were encouraged to maintain the limited skills and independence. There are currently several members of staff who have either completed, or are working towards, achieving NVQ2 or 3. This will be increased shortly when further members of staff have secured funding for this recognised training. The home employs several members of staff from overseas who have a professional nursing qualification in their own countries. These staff work as care assistants at the home and provide a high level of knowledge, skills and experience to look after residents. Staff training has expanded since the last inspection and courses relating to food and hygiene, fire, manual handling, safe handling of medication and first aid are planned for the near future. Twenty members of staff are booked to attend advanced dementia training which will be carried out in the home by a professional trainer. This will greatly assist staff to look after residents in the home who have this condition. A local Clinical Psychiatric Nurse also visits the home regularly and the staff gain her advice/guidance/support on residents with dementia - and how best to care for them. Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 23 New staff are recruited and undergo a formal induction period, when they complete a booklet with a senior member of staff which demonstrates their competence to do their jobs properly. Three staff files were looked at, including those staff most recently recruited. All of these files contained all the information required and the home has improved its recruitment procedure considerably since the last inspection. Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 24 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): 21, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides leadership, guidance and direction to staff to ensure residents receive good quality care. There are good systems in place for resident consultation and evidence to show that their views are sought and acted upon. There are good systems in place to ensure that the health, safety and welfare needs of residents are protected. EVIDENCE: The management of the home has improved significantly with both the owner and manager working extremely hard to improve the standard of care delivered at Chelfham. The manager has the appropriate qualifications to run a care home and has increased her skills and knowledge substantially since the Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 25 last inspection. The manager is well respected by her staff and comments such as “I think the management does many things to improve quality service at Chelfham House” and “Management is very helpful and approachable”. Resident and relative questionnaires confirmed their confidence in the management of the home and commented “Owner and staff all helpful and informative” and “The manager is always available to meet at any time”. Currently the organisational structure of the home includes a manager, deputy manager, senior care staff and care staff. However, when management are not on duty, the role of the senior carer (with their responsibilities) is not well defined. The manager is reviewing this. Regular supervision now takes place with all staff, both on an informal and formal basis. Staff felt that this was very useful and has helped them focus on their work and training needs to improve the care they give to residents. Regular resident/relative meetings are held which enables management to listen to their views and specific topics to be discussed, for example changes in food menus and whether they were liked or not. Relatives find these useful and commented that they felt involved in the residents’ care. A quality assurance document had recently been sent out and the inspector saw that any negative comments had been acted upon and resolved. The home now also produces a monthly newsletter which lets everyone know of forthcoming events in the home and other interesting information relating to residents, for example residents reminiscing about their previous lives. Residents and relatives are encouraged to manage personal finances and the home looks after pocket money relating to one resident only with suitable records kept. The pre-inspection questionnaire shows that the equipment used in the home is regularly serviced and maintained properly. The fire logbook was looked at and found to be satisfactory. Any incidents or accidents to residents in the home are recorded and held appropriately. Any substances, which can be hazardous to health, were all kept secure and locked away, preventing any harm to residents and visitors to the home. Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 26 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 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP10 Regulation 12 (4) a Requirement When medical/health/personal care is being delivered to people who use the service, it must be done in a private place away from communal areas. This is to ensure that people are looked after in a respectful and dignified way People using the service who have a dementia related illness, must be looked after by staff who have undergone training in this subject and have a good understanding of the illness. This is to ensure that staff can confidently meet all these people’s needs fully Timescale for action 30/05/07 2. OP30 18 (1) c 15/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard 1.Good Practice Recommendations Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 28 1. OP7 It is recommended that work continues of the resident care plans and risk assessments to ensure that they contain all the information required and are personcentred. It is recommended that the environment continues to be upgraded to raise the overall standard of the home. 2. OP19 Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Chelfham House DS0000062357.V331281.R01.S.doc Version 5.2 Page 30 - 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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