Inspection on 05/04/07 for Cheney 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 Poor. 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

Cheney House 14/05/09

Cheney House 08/12/08

Cheney House 28/02/08

Cheney House 06/04/06

Cheney House 11/10/05

Cheney House 20/04/05

Cheney House 16/12/04

Cheney House 01/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Cheney House Rectory Lane Middleton Cheney Banbury Oxon OX17 2NZ Lead Inspector Kathy Jones Key Unannounced Inspection 5th April 2007 07:45 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 Cheney House DS0000012735.V335392.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. Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheney House Address Rectory Lane Middleton Cheney Banbury Oxon OX17 2NZ 01295 710494 01295 712784 cheney@regalcarehomes.com www.regalhomes.com Regal Care Homes Ltd 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) Ms Marie Williams Care Home 34 Category(ies) of Dementia - over 65 years of age (34), Old age, registration, with number not falling within any other category (34) of places Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No person falling within the category of DE(E) may be admitted into Cheney House where there are 34 service users who fall within the category of DE(E) already accommodated within the home. No person falling within the category of OP may be admitted into Cheney House where there are 34 service users who fall within the category of OP already accommodated within the home. 11th August 2006 Date of last inspection Brief Description of the Service: Cheney House is a care home providing personal care and accommodation to thirty four older people who may have a dementia related illness. It is owned by Regal Care Homes Ltd. Cheney House is located in the village of Middleton Cheney The Home is situated within its own grounds and located in a village. Middleton Cheney has amenities such as three churches, shops, post office, chemist, doctor’s surgery and three public houses. The village is on a bus route to the town of Banbury, which is approximately three miles away. The building was a former rectory and is a listed building. There are nineteen single bedrooms with nine having en-suite toilet facilities. Of the eight rooms, which are shared by two people, two have en-suite toilets. The fees confirmed by the registered manager as being current on 12 April 2007 range between £361 and £500 per week. The fees for privately funded residents’ range between £400 and £500. The service user guide explains that the difference in fees will be dependent on the care needed and room chosen. The fees include accommodation, personal care, meals, laundry and some activities and entertainment. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include clothing, dry cleaning, some outings and toiletries. Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of the information held by the Commission for Social Care Inspection as part of the pre-inspection planning and an unannounced inspection visit to the service. The pre-inspection planning was carried out over the period of a day and involved reviewing the service history, which details all contact with the home including notifications of events reported by the home, telephone calls, letters, and details of any complaints and concerns received. The reports from the most recent inspections in April and August 2006 were reviewed and the findings taken into account when planning this inspection. A pre-inspection questionnaire submitted by the registered manager provided information, which has been taken into account as part of the inspection process. The views of five residents who completed questionnaires with the assistance of staff and ten relatives who forwarded questionnaires have also been included in this report. The unannounced inspection visit covered the morning and afternoon of a weekday. The inspection was carried out by ‘case tracking’ which involves selecting residents’ and tracking their care and experiences through review of their records, discussion with care staff and observation of care practices and the environment. The majority of residents have dementia, and although the inspector spoke with them, judgements have been based mainly on observations of their general well being and the care they were receiving and from the views of relatives. A sample of staff files were reviewed to check the adequacy of the recruitment procedures and training received. The findings of the inspection were discussed with the registered manager at the time of the inspection. The more immediate concerns relating to the unguarded heating appliances, movement and handling training and staffing levels were discussed with the responsible individual for Regal Care Homes in a telephone call following the inspection. What the service does well: Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 6 Several positive comments were received from relatives about what the service does well. These include. “A happy environment”, “ provides a friendly caring service, to all residents”, “involving residents in activities”, “good home cooking”. Relatives spoken to during the inspection also felt that it was important to them that the care home was local, and that they were able to visit as and when they wished. Prompt action was taken to request a General Practitioner visit for a resident who was poorly and the District Nurse said that they were contacted appropriately for advice about residents’ health care. Residents and relatives said the food is good and one relative described it as “good home cooking”. The home was refurbished last year and relatives have commented on the improvement that this has made to the environment that residents live in. What has improved since the last inspection? What they could do better: While there have been improvements in the information provided in the service user guide, more clarity and accuracy regarding the range of fees would help prospective residents and their families have a better understanding of the costs. Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 7 While improvements were found in the care planning documents, some concerns were identified in the way that care was provided to some residents. For example the recommended assistance with the management of continence, meeting the needs of a resident unable to express their needs through language and hair care carried out in the corridor and lounge. Better recording of complaints, concerns and allegations needs to be carried out so that recurring problems can be identified and acted on and so that there is clear evidence that everything that can be done to protect vulnerable people has been done. Several breaches of regulations have been identified during this inspection and those that have caused the most concern in relation to the risk to residents, have been raised at previous inspections. For example, the risk to residents’ of burning from unguarded heating appliances, staff not trained to carry out movement and handling and poor recruitment procedures. All of these concerns have been raised and requirements made at previous inspections, raising concerns about the continuing commitment to complying with legislation and protecting residents. 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. Cheney House DS0000012735.V335392.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 Cheney House DS0000012735.V335392.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): 1, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission process establishes the homes ability to meet the needs of people admitted to the home prior to admission and information is available to help people make a decision. However more clarity and accuracy about the fees is needed. EVIDENCE: There is a statement of purpose and service user guide, which provides clear information about the services provided and needs catered for. This information is particularly useful for prospective residents and their families when trying to choose a care home and appears to contain more information and to have an improved layout since the last inspection. Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 10 Three out of five questionnaires received from residents’ stated that they felt that they had received enough information about the home before they moved in, while two said that they hadn’t. The service user guide provides additional information about what to expect at Cheney House. This includes information about the current fees and what is and what is not included in the fee. However this document, which was updated on 26 March 2007, when checked against the information received from the manager was inaccurate in relation to the range of fees. It was also not clear what was meant by “specialist one to one care”, which was listed as an additional charge. Advice was given to include more information about this, however the registered manager said that no-one was paying this extra cost at present. Comments from relatives indicate the need for more clarity in relation to additional or ‘top up’ fees for residents funded by the local authority. Records for a recently admitted resident were reviewed to check the adequacy of the assessment process in helping to ensure a prospective residents needs can be met. Information gathered as part of the assessment included an assessment carried out by the registered manager and an assessment carried out on behalf of the local authority. Review of all of the documents indicated that there was sufficient information to make a decision about meeting the residents’ needs. Cheney House DS0000012735.V335392.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 poor. This judgement has been made using available evidence including a visit to this service. Improvements in care planning provide staff with better information about residents needs and medical advice is sought where appropriate. However basic care needs are not consistently met with regard to the dignity of residents. EVIDENCE: Three questionnaires received from residents said that they receive the care and support that they need and two said that they usually do. Mixed views were also received from relatives with two stating that the care home always meets the needs of their relative, six stating that they usually do and one that they never do. One relative said that they would like their relative to be cleaned up after meals and their hair cared for. Similar comments have been received from other relatives about the need to regularly prompt staff to ensure that Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 12 residents’ receive basic care such as their teeth cleaned and put in, and their hair brushed. Reminders to staff were seen around the home about residents’ personal care, however these seem to have had little effect. The inspector saw residents being brought downstairs by staff on the morning of inspection with unkempt hair. Staff brushed some of the residents’ hair in the corridor with a hairbrush kept in the office and one resident had her hair brushed in the lounge. These practices are neither dignified nor hygienic and concerns have been raised on a previous inspection about the use of communal hairbrushes. A sample check of residents’ care plans showed that there has been an improvement in the information provided to guide staff in meeting residents needs. Additional documentation has also been put in place such as records to support continence management. It is however of concern that the records do not in all cases correspond with the care provided or the care recommended. For example the toileting chart that had been developed showed between a two and a four hour planned frequency. Staff are expected to sign to confirm that they have assisted residents to the toilet, however the actual time is not recorded which means that there can be even longer gaps. The registered manager advised that the continence advisor had assessed only a small number of residents as requiring continence products and advised that residents should be assisted to the toilet every two hours to help them maintain their continence. The registered manager advised that there were not always sufficient staff to do this. An incident during the inspection confirmed that residents’ are not sufficiently supported in the management of continence and maintenance of dignity. While staff were observed to speak to and treat residents with respect, the lack of adequate support to some residents in managing continence does not allow them to maintain their dignity. A resident was observed to be taken into the conservatory and heard to be making repetitive sounds which other residents’ were finding irritating. After approximately forty minutes the resident was taken back to their room and was heard to continue to make loud repetitive sounds. There was no evidence from observations of an appropriate strategy to relieve this residents’ apparent distress, and the distress appeared to increase through isolation. The registered manager advised that they had found that the television increased the residents’ distress and music sometimes had a calming effect. The resident was observed by the inspector to be in their room with the television on, confirming the lack of consistent and appropriate strategies to meet this resident’s needs. A District Nurse, who was visiting during the inspection, said that her team were contacted appropriately for advice and support. The District Nurse advised that she had recommended a high protein diet for a resident who was being treated for a pressure ulcer to help with the healing of this. Later review Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 13 of the care plan identified that this advice was not reflected in the plan, creating a risk that the advice may not be followed. There was evidence that prompt action is taken in respect of any physical deterioration in the health of residents’. During the inspection the health of a resident deteriorated and as soon as informed of this by staff the registered manager gave this immediate priority demonstrating a caring approach. Referral to the General Practitioner was also made in a timely manner. Comments from residents’ indicate that they are kept well informed about serious illnesses but not always notified of falls with minor injuries. A small sample check of the medication system was carried out which identified that systems were in place for the safe management of medication. The Assistant Care director had carried out a recent medication audit and the registered manager was addressing the issues identified. Cheney House DS0000012735.V335392.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): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities are provided and contact with friends and families encouraged through flexible visiting arrangements, which improve residents’ daily lives and residents were happy with the meals. EVIDENCE: Four questionnaires from residents say that there are activities that they can take part in and two said that there usually is. On the day of the inspection two volunteers from the local church were visiting the residents, they knew all the residents by name and appeared to have built up a good rapport with them. Residents seemed pleased with the visit and some were enjoying hand massages and later some residents, were involved in a game of quoits, which was enjoyed, by both participants and onlookers. A questionnaire received from a relative talks about residents being involved in craft making, gardening and bingo. The volunteers from the church appear to have built up a good relationship with members and none members of the church and visit weekly. A monthly Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 15 church service is held in the home for those residents who wish to take part. Information about residents’ religious needs and the support that they need is included in their care plans, however review of one of these identified that there was conflicting and confusing information. The resident was described as “unable to follow their religion” and the aim of the care was detailed as “to have support to follow religion”, however records show that the resident did not practice a religion. Clear and accurate information is vital in ensuring that resident’s receive the support they need or equally have choice as to whether they participate in religious activities or not. It was difficult in some instances to evidence how choices have been given and residents consulted. For example the daily records for a recently admitted resident show that they had been admitted to a particular room and a letter on file confirmed that they had been allocated this room. However the resident was in a different room just over a week later. There was nothing in the resident’s records to show if and who had been consulted or of the reasons for this move. There are flexible visiting arrangements and a relative said that they were able to visit as and when they wished. Two relatives said that they liked to visit and assist at meal times, as they liked to be reassured that their relative was eating. They were also pleased that their relatives were local which helped them to be able to visit every day. The practice appears to be that visits take place mainly in the lounge. A questionnaire from a relative indicates that they would like to be able to visit in private sometimes, indicating a need for staff to check individual preferences and for residents and relatives to be made aware that arrangements can be made for private visits. A relative was appreciative of relatives being able to join in with parties throughout the year, which also helps the quality of life for residents. Residents and relatives all seemed happy with the meals provided. Questionnaires from five residents’ said that they like the meals and one usually does. A staff member serving breakfast to residents was aware of their individual preferences. On the day of the inspection the lunch consisted of beef casserole and dumplings with vegetables and coconut sponge with custard for dessert. The inspector tasted the meat and found that it was tender and tasty. Residents were given the assistance that they needed with their meals. Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and the majority of relatives were aware of the procedures for making a complaint, however poor record keeping in respect of the action taken makes it difficult to confirm appropriate action has been taken to safeguard vulnerable people. EVIDENCE: Since the last inspection the Commission for Social Care Inspection (CSCI) have received one complaint, which was referred to social services for investigation under safeguarding adults procedures. This complaint has been investigated by social services who are going to monitor the actions taken in respect of improved record keeping regarding accidents and improved standards of personal care for the resident. It was not possible to review the actions taken in respect of the allegations, as none of the relevant records were available at the time of the inspection. The registered manager advised that they had been taken to head office and would be forwarded to CSCI following the inspection. Regal Care Homes have also notified CSCI of allegations which were made against a member of staff, and which they had reported to the police and safeguarding adults. CSCI were informed that the staff member was initially Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 17 suspended and then left, however there are no records to confirm the actions taken in respect of these concerns or evidence of liaison with the police regarding the outcome of their investigation. While it would appear that appropriate action was taken to protect residents at Cheney House, the lack of appropriate records and evidence of how the protection of other vulnerable people has been considered has the potential to put people at risk. Questionnaires received from five residents say that they know who to talk to if they have any concerns. Questionnaires from seven relatives say they know how to make a complaint, while three say they don’t. Information about how to make a complaint and who to contact is detailed within the service user guide. Discussion with a relative and later the registered manager indicated that the residents’ whose relatives do not know about the complaints procedure may have been admitted before these documents were developed. Advice has been given to make them available to all relatives. There is a record of complaints held in the home. There are none recorded since July 2006. Comments from relatives indicate that issues have been raised with the manager about concerns such as personal care and laundry, which she has dealt with at the time but then they seem to recur. These concerns have not been recorded and therefore it is more difficult for the manager to isolate the problem. Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have a clean and comfortable home to live in, however failure to protect residents at risk of falls from unguarded and free standing heating appliances puts them at serious risk. EVIDENCE: The lounges, conservatory and a sample of residents’ bedrooms were seen during the inspection. All of these areas were clean and comfortably furnished. Two residents confirmed that the home is always fresh and clean and three said it usually is. A relative commented that the environment has improved since the refurbishment last year. There is an enclosed garden accessible via the Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 19 conservatory, which a relative describes as a typical rectory garden and says that there is a good summer house, however feels that the garden furniture should be cleaned up for the summer. The garden did appear to be in need of some tidying up for the summer, however at the time of the inspection the handyman was doing some work in the garden and a resident said she was looking forward to going into the garden when the warmer weather arrived. During the inspection the inspector noted that there were two unguarded radiators in the conservatory and two free standing radiators. All of these appliances were so hot it was not possible to put a hand on them. One of the free standing heaters in particular was in a position where a resident could very easily have fallen over it creating a risk of burns. In view of the high risk the registered manager was required to take immediate action to safeguard residents. Following the inspection discussion has taken place with the responsible individual for Regal Care Homes Ltd about this risk, which is of particular concern, as a requirement has been made at a previous inspection regarding this risk to residents. Confirmation has been received that this additional heating is not currently required due to the improved weather and that the matter is being investigated. Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to this service. Inadequate recruitment procedures and staffing levels put residents at risk. EVIDENCE: On arrival at the home at approximately 7-45am there were two members of staff on duty with thirty three residents. These two members of staff had been the only staff on duty since 8pm the previous evening. Given the needs of the residents and the layout of the building it is not possible to see how residents needs can be properly met with these staffing levels, particularly during the early morning and evening when residents need assistance with getting up and going to bed. Comments from some relatives support the need for more staff at times. Requirements have been made following previous inspections about staffing levels and assurances given that they would be increased, however they do not appear to have been maintained. Advice has been given that the needs of the residents’ throughout the twenty four hour period must be taken into account and sufficient staff provided to meet those needs. The findings detailed under health and personal care relating to the management of continence indicates the need for a full review of residents needs in relation to staffing levels to ensure needs are fully met. Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 21 Comments received from relatives indicate that the majority are satisfied that staff have the right skills and experience to meet residents’ needs however two highlight problems with communication with some staff whose first language is not English. One relative says that they mean well but there are sometimes problems with understanding. At the present time the percentage of staff who have achieved a National Vocational Qualification (NVQ) is very low, however some other staff are currently undergoing training and the NVQ assessors were visiting at the time of the inspection. The NVQ is an important qualification as it provides staff with a basic understanding of care practices and the needs of older people. A record of planned training includes dementia care training and abuse and is considered particularly important in helping staff meet the needs and protect residents. Certificates had not yet been received to evidence recent movement and handling and fire safety training. Shortfalls in relation to movement and handling training are detailed in the management section of this report under safe working practices. Induction training could not be evidenced for a new member of staff, as the records were not available for inspection. The registered manager advised that the staff member had taken them home. Advice was given to ensure that copies are kept in the home in order that training to meet the needs of residents’ can be verified. A sample check of staff files was made to look at the adequacy of the recruitment process in protecting residents. Two files of staff who have been employed since the last inspection were reviewed. It was difficult to establish the exact start date for one member of staff as two different dates were shown on records. However records indicate that both staff were employed prior to receipt of a criminal record bureau clearance and from the information within the records at least one had been employed prior to receipt of a check of the protection of vulnerable adults register. There was also no evidence of any supervision arrangements in place to safeguard residents prior to receipt of a criminal record bureau clearance. Gaps in an employment history had also not been checked. Failure to carry out a rigorous recruitment process puts residents at risk through possible employment of people who are unsuitable to work with vulnerable adults. It is of particular concern that these issues have been raised following previous inspections and requirements made. Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management arrangements do not adequately safeguard residents. EVIDENCE: The registered manager has been in post for approximately three years and prior to that she had worked for several years at Cheney House. The registered manager holds a National Vocational Qualification level 4 in management and care. Some positive comments have been received from relatives about the registered managers commitment to residents and this was supported by her response to a resident whose health deteriorated during the inspection. One Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 23 relative has said that the home has improved since she has been in post and another that she deals with concerns that are raised. However one relative says that the overall organisation and administration could be improved. This is also confirmed by the inspection findings, which have highlighted breaches of regulations, which have been raised during previous inspections and have the potential to put residents at risk. Since the last inspection additional quality assurance processes have been implemented. These consist of audits in areas such as medication management and care planning. The registered manager advised that the care director or assistant care director carries these out and that the registered manager then rectifies any identified shortfalls. These additional processes indicate improved monitoring of the service by the organisation, however the findings of this inspection identify the need for a more in depth review of the service provided. Discussion with staff, the registered manager and review of records identified that one and possibly more staff members had been carrying out movement and handling of residents without having received appropriate training. This puts staff and residents at risk of injury and is also of particular concern as concerns about poor movement and handling practice have been raised at previous inspections. A statutory requirement to ensure that all staff moving and handling residents have received training, has been issued prior to completion of this report in order to safeguard residents. Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 24 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 1 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X X X 1 Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12 (4) (a) Requirement Residents must be assisted to maintain appropriate standards of personal care and grooming in a manner, which respects their dignity. Advice regarding the care of residents from health professionals such as the continence advisor must be implemented. Clear and consistent strategies based on professional advice, must be in place to support residents’ whose behaviour may impact on others and help maintain their mental well being. Detailed records must be kept of all complaints and allegations and the actions taken to protect residents and other vulnerable people. Action must be taken to protect residents from the risk of burning from unguarded heating appliances and radiators based on risk assessments. (Written response of action taken by 12/04/07) DS0000012735.V335392.R01.S.doc Timescale for action 08/05/07 2. OP8 12 (1) (a & b) 08/05/07 3. OP8 12 (1) (b) 14/05/07 4. OP16 17 (2) schedule 4 – 11. 13 (4) (c) 14/05/07 OP18 5. OP19 05/04/07 Cheney House Version 5.2 Page 26 6. OP27 18 (1) (a) 7. OP29 19 (1) (b, c) 8. OP31 OP33 10 (1) 24 (1) 13 (5) 9. OP38 There must be sufficient staff at all times to meet the individual needs and preferences of residents. Prior to staff starting work in the home there must be evidence to confirm a thorough recruitment process, which includes up to date references, criminal record bureau clearances and a full work history. (This is an unmet requirement from 30/04/06 and 15/09/06) Management and quality assurance systems must be sufficiently effective to ensure that residents’ needs are met and they are not put at risk. All staff moving and handling residents must have received training to reduce the risk of injury. (Written response of action taken required by 12/04/07) 08/05/07 08/05/07 30/05/07 18/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP1 OP13 OP14 OP28 OP30 Good Practice Recommendations The information about fees in the service user guide should be kept up to date, be accurate and include any ‘top up fees’. Residents and relatives should be offered the opportunity to have visits in private. Records should demonstrate how residents are consulted over things such as a change of room and how they are given choice and control over their lives. Staff training records including induction records should be accessible and kept available for inspection. Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Cheney House DS0000012735.V335392.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!