Inspection on 06/04/06 for Cheney House

This inspection was carried out on 6th April 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

Cheney House 14/05/09

Cheney House 08/12/08

Cheney House 28/02/08

Cheney House 05/04/07

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 Mrs Kathy Jones Unannounced Inspection 6th April 2006 08:00 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.V288931.R01.S.doc Version 5.1 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.V288931.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cheney House Address Rectory Lane Middleton Cheney Banbury Oxon OX17 2NZ 01295 710494 01295 712784 cheneyhouse@regalcarehomes.com 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) Regal Care Homes Ltd 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.V288931.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No person falling within the category of DE(E) may be admitted into the home 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 the home where there are 34 service users who fall within the category of OP already accommodated within the home. 11th October 2005 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. Regal Care Homes Ltd has owned the home since January 2004. The Home is located in the village of Middleton Cheney, which has shops including a chemist and supermarket, a doctor’s surgery and three public houses with restaurants. The building was a former rectory and is a listed building, which is situated within its own grounds. All of the communal facilities are located on the ground floor. There is a large and a smaller communal lounge and a conservatory area. Some dining tables are located in each of the communal areas. There are bedrooms on the ground and first floors with a small passenger lift providing access to the first floor. Nineteen bedrooms are single with nine having en-suite toilet facilities. Of the eight rooms, which are shared by two people, two have en-suite toilets. There is one bathroom containing an assisted bath and one with a domestic type bath on each floor. The top floor of the building is used to provide living accommodation for newly appointed overseas workers. The following fees were provided by the registered manager as being current at the time of the inspection on 6 April 2006: • Privately funded residents in room shared by two people - £400 • Privately funded residents in a single room - £450- £500 dependent on whether the room has en-suite facilities. Fees for residents funded by Local Authorities vary and are paid according to their agreed rate. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 5 The fees include personal care, accommodation and meals. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include clothing and toiletries. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. All standards identified as ‘key’ standards and highlighted through the report were inspected. These standards are those considered by the Commission to have a particular impact on outcomes for residents. This was achieved through review of existing evidence, pre-inspection planning, an unannounced inspection visit to the home and drawing together all of the evidence gathered. The review of evidence and pre-inspection planning was carried out over the period of one day and involved reviewing the report of the inspection carried out in October 2005, reports of two additional inspection visits undertaken following the inspection to monitor compliance with requirements, reviewing notifications of events reported by the home, telephone calls received and the findings of two complaints. The information gathered assisted with planning the particular areas to be inspected during the visit. The unannounced inspection visit covered a period from early morning until late afternoon on a weekday. This was carried out through talking to residents, staff, relatives, health professionals and the registered manager. Observations were made of residents’ general well being, daily routines and interactions between staff and residents. A sample of residents care records were reviewed to check how residents’ care and health needs were being assessed and how their care was planned and supported. Staff training was discussed with staff and two files for newly recruited staff were reviewed to check the adequacy of the recruitment process. A sample of residents’ bedrooms and bathrooms were viewed with the registered manager during the inspection. Feedback on the inspection findings was given to the registered manager throughout the inspection visit and concerns regarding staffing levels discussed with the responsible individual at the end of the inspection. What the service does well: Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 7 One of the strengths of the service is the way that relatives and other visitors are made welcome in the home. Throughout the day staff welcomed visitors in to the home. Relatives spoke very positively of the support and care that a resident had received particularly through a recent illness. Prospective residents and relatives are encouraged to visit the home prior to a resident moving in. A relatively new resident said that she had settled in well and one of the things she had particularly enjoyed since she had been in the home was the food. Relatives commented favourably on the re-decoration and refurbishment, which they felt, was a big improvement for residents. Lounges, residents’ bedrooms and bathrooms were all clean and free from odour. Staff spoke to residents and about residents in a respectful manner. Staff had developed good relationships with residents and one resident was enjoying some friendly banter with them. The home has developed good relationships with the pharmacist, resident’s medication is managed well and staff receive training in handling medication. What has improved since the last inspection? What they could do better: The process for assessing the needs of residents before they move into the home is not very thorough, making it difficult to ensure that residents’ needs can be properly planned and met. For example there was no information about when a resident’s hip fracture had happened and how this affected the assistance that she needed. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 8 More information about the range of needs that the home is able to accommodate would provide prospective residents and their families with a better understanding of the care the home is able to offer and identify any circumstances when the home may not be able to continue to provide the care. Care plans which are in place to guide staff in providing appropriate care for residents contain mainly minimal generalised information such as “needs help at all times” without identifying residents’ particular needs and preferences. Unidentified toothbrushes and sponges in shared bedrooms indicate a lack of respect for residents and their belongings as well as posing an infection control risk. Several issues of concern, which were identified and addressed previously have re-emerged, such as a deflated pressure mattress, loose bed rails, lack of robust recruitment procedures and poor staffing levels. In order to protect residents and ensure their care and health needs can be properly met urgent improvements need to be made in the management and oversight to improve and maintain standards of care. Confirmation has been received that staffing levels have been increased immediately following the inspection. However at the time they did not meet the needs of residents and it is of concern that it was necessary for the inspection to prompt this. 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. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 – Std 6 is not applicable as intermediate care is not provided. Quality in this outcome area is adequate. The admissions process provides no assurances that residents’ needs can be fully met. EVIDENCE: A recently admitted resident couldn’t recall receiving any written information about the home prior to moving in however she was happy to move there on the recommendation of a relative. The home does have a statement of purpose, which provides information for prospective residents and their families and the manager confirmed that a copy is given to all prospective residents and their families who are then invited to visit the home. The information includes aims and objectives and philosophy of care. The statement of purpose is a standard format used by the company for all of their homes. The responsible individual has advised that it is her intention to make each statement of purpose more specific to the individual home. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 11 At the time of the inspection the inspector was informed that the company are reviewing their ability to care for residents with high dependency needs. Advice was given to ensure that this is clearly detailed within the statement of purpose in order that prospective residents and their families are clear about the range of needs that the home is able to accommodate and if there is any possibility of them having to move if their needs change. Residents funded by the local authority do not currently have a statement of the terms and conditions, which is an area to be addressed. Privately funded residents have a contract. Review of a newly admitted residents’ care file confirmed that an assessment of need is carried out prior to residents being admitted to the home and an assessment is also obtained from the local authority where applicable. However review of the information gathered identified that it was very minimal with insufficient evidence that the actual care needs had been considered. For example the assessment for one resident identified in their medical history a fractured hip, however the registered manager was not aware if this had been a recent fracture. Discussion with the registered manager and health professionals confirmed that more consideration should be given to prospective residents’ immediate and also ongoing care needs when making a decision as to the home’s ability to meet those needs. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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 adequate. While residents and relatives appeared satisfied with the level of care, the lack of adequate care plans to support the care and failure to ensure pressure relieving equipment is effectively maintained puts residents at risk of their health and care needs not being met. EVIDENCE: Two relatives spoken to were very happy with the care provided particularly during the recent ill health of the resident. They felt that their wishes about the care had been taken into account. Two residents spoken to during the inspection confirmed that they were happy with the care and support that they received. Residents’ care plans very basic and had not been completed fully to incorporate their needs and preferences. There was insufficient information in the care plans to instruct staff in the actions required of them to meet Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 13 residents needs’, for example a movement and handling plan stated “needs help at all times”, but there was no information about the nature of the help needed. A movement and handling plan for a resident who has recently had a fractured hip did not include this information which is important for staff to be aware of when providing assistance. Conversations on the telephone and during the inspection with District Nurses identified that referrals to them are made appropriately and that the manager is receptive to advice given. Pressure area risk assessments have been introduced and a District Nurse advised that arrangements had been made to provide a teaching session for staff on pressure area care. During a sample check of residents’ bedrooms a deflated pressure mattress was found on a resident’s bed creating an increased risk of pressure sores. Discussion with staff, a sample check of medication and observation of medication administration confirmed that there is a safe system in place for managing residents’ medication. A staff member spoken to confirmed that she had received medication training. Staff were heard to talk to and of residents in a respectful manner. Discussion with a resident and a sample check of shared bedrooms confirmed that privacy curtains are in place. Toothbrushes were found on the sinks in shared rooms with no means of identifying whom they belonged to. A member of staff was also unsure. The registered manager acknowledged that in addition to the infection control issues this showed a lack of dignity and respect. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 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 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 adequate. Visitors are encouraged and welcomed into the home and residents are happy with the food provided, however resident’s choices are limited by the organisation and staffing of the home. EVIDENCE: Residents’ choices in relation to the routines of daily life are limited by the organisation and staffing of the home. On the morning of the inspection residents told the inspector that some of them are woken early in the morning, as staff can’t get them all up at a later time. Staff confirmed that they start waking and getting residents up from 5-45am and that there are a certain number who have to be up before the day staff start work at 8am. Of the nine residents in the lounge at 8-20am seven were asleep in their chairs. Relatives were visiting throughout the day and two relatives confirmed that they are able to visit as and when they wish and that they are welcomed into the home. Improvements had been made in relation to the provision of activities. However on the day of the inspection care staff time was mainly taken up with Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 15 meeting residents’ physical care needs. Several residents were noted to be ‘wandering’ with little to occupy them. During the inspection two members of the local church were visiting the home to discuss with the registered manager arrangements for a small group of volunteers to visit the home on a regular basis to spend time talking and arranging activities for residents. It was felt that this additional resource if managed effectively could improve the daily lives and social contact for residents. The local vicar is hoping to arrange some church services in the home for those residents who wish to take part in. The need to include more information about how the home intends to meet residents’ cultural and religious needs and expectations in care plans was discussed. Discussion with the cook identified that there is a four week menu plan in place, which has been adapted according to residents’ preferences. There is no choice of main meal noted on the menu, however the cook advised that alternatives can be provided and that she asks the residents what they would like each day. A separate and varied menu is provided for a vegetarian resident. The cook confirmed that she has received food hygiene training and also some training in nutrition. Three residents spoken to said they enjoyed the food, which on the day of inspection was chicken and mushroom pie with new potatoes, carrots and cabbage, with sponge and custard for dessert. Observations of the service of the lunch time meal highlighted that there was insufficient room at the dining tables to accommodate all of the residents and some were sitting in armchairs eating from small over arm tables which in some cases were placed too far away for the resident to reach easily. A high number of residents need assistance with meals; some need feeding while others need prompting. The six staff who were feeding residents were doing so with sensitivity and a member of staff assisting a blind resident explained exactly what the meal was prior to assisting her. However staff were unable to adequately assist those residents who needed reminding and prompting to eat, resulting in some of their meals becoming cold. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 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 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. Concerns raised are not adequately addressed at an early stage resulting in complaints being referred to CSCI. Recruitment procedures do not properly safeguard residents from harm. EVIDENCE: The registered manager advised that no complaints have been received by the home since the last inspection. Concerns raised about standards of care are not currently recorded however advice has been given to keep a record of these together with details of action taken. The Commission for Social Care inspection (CSCI) has received two complaints since the inspection carried out in October 2005. The first complaint related to a resident’s bedding being found wet on more than one occasion and an action plan was forwarded to CSCI following an investigation carried out by the responsible individual. (No concerns about the cleanliness of bed linen were identified during this inspection.) The second complaint related to infection control, which was not founded. However concerns that overseas staff were working excessive hours was founded. As detailed in the staffing section action has been taken to monitor this. District Nurses recently contacted CSCI about the safety of a hoist used for the movement and handling of a resident as no action had been taken by the Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 17 home in relation to their concerns. While this was referred back to the responsible individual who arranged for a new hoist to be purchased, it highlights the need for the organisation to review the way that concerns are dealt with and acted on. A resident and two relatives confirmed that they felt able to raise any concerns that they may have and the relatives were confident that appropriate action would be taken. Staff are clear about their responsibilities for protecting the vulnerable people in their care from abuse and reporting any concerns. However the failure to put in place and maintain a robust recruitment and selection processes for staff as detailed in the staffing section, puts residents at risk. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 26 Quality in this outcome area is good. The re-decorations and refurbishment have improved the environment for residents and the additional safety checks have reduced the risk. EVIDENCE: Some recent re-decoration and refurbishments have been carried out which relatives confirmed have improved the appearance of the home and comfort for residents. The registered manager confirmed that all necessary maintenance and safety checks/works have been carried out, including electrical work, with the exception of some work, which requires the heating to be switched off. It was confirmed that this would be done as soon as the weather is warmer. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 19 A sample check of residents’ bedrooms identified that they were free from odour and bed linen was clean. While the rooms were generally clean it was of concern to note that in some cases tablets of soap in shared rooms were cracked and ingrained with dirt creating an infection control risk. Staff were also unable to identify which toothbrush belonged to which resident. There are four bathrooms in the home, with an assisted bath and a domestic type bath on each floor. The domestic baths are unsuitable for the majority of residents due to the difficulty in access and are therefore rarely used. A review of the provision of aids and adaptations to include the suitability and sufficiency of the existing bathing facilities in relation to residents needs should be carried out. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 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 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 poor. Failure to maintain adequate staffing levels and follow thorough recruitment procedures puts residents at risk. EVIDENCE: Staffing levels were insufficient to meet the needs of residents at the time of the inspection. For example there were only two staff on duty between the hours of 8pm and 8am with 32 residents. The majority of residents have dementia and require varying levels of support/assistance and/or monitoring and supervision. Nine residents require two members of staff for all assistance with their physical care needs. If assistance is required while there are only two members of staff on duty this leaves 31 residents without any supervision/assistance. See also comments in the ‘Daily life and Social Activities’ section relating to assistance with meals. Evening and early morning staffing levels have been raised as a concern by inspectors previously and levels were increased following requirements made. The responsible individual confirmed in an e-mail following the inspection that staffing levels had been increased again and should be maintained if necessary through the use of agency staff. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 21 Discussion with residents identified that they do not have a choice about the time they get up and are woken up from 5-45am onwards. These residents were asleep in their chairs in the lounge by 8-20am. Staff confirmed that there was no system of identifying residents’ preferred routines on admission to the home and that the routines of the home and staffing levels were the deciding factor with times for getting up which meant waking some residents up. A complaint received by CSCI since the last inspection related to staff working excessive hours. This complaint was founded however a sample check of the staff rota during the inspection and discussion with staff confirmed that this matter has now been addressed. The responsible individual has confirmed that she intends to monitor staff rotas more closely to ensure that there is sufficient staff to meet residents’ needs. There is a programme of staff training in place and a staff member advised this includes dementia care training, infection control, medication training and movement and handling training. The staff team consists of a mixture of local and overseas staff. The overseas staff have been trained as nurses in their home country and some of the local staff have been or are being trained to National Vocational Qualification level 2. The company have recently introduced a new induction programme based on the National Training Organisation specifications. It was not possible to review the use of them, as the comments were held by the individuals and not available for inspection. Discussion with two relatively new staff identified that they were unclear about the induction process. There was no evidence that a robust recruitment procedure to protect residents is in place. Files for two recently recruited staff identified that neither had Criminal Record Bureau clearances or evidence of POVA First checks and in one case references were outdated. An application form was incomplete without a full work history and there was no evidence of interview or selection process. At the time of the inspection all residents were White British with some staff White British and other staff recruited from overseas. The registered manager advised that more care has recently been taken to check the language skills of overseas staff due to previous problems with understanding for some residents. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. The reporting/decision making structure between the registered manager and head office needs to be agreed and formalised to provide strong leadership, accountability and overview of the home to ensure that regulations and residents needs are fully met. EVIDENCE: The acting manager has been registered with CSCI as manager since the last inspection. The registered manager confirmed that she has completed National Vocational Qualification level 4 Registered Managers Award and dementia care training since the last inspection. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 23 Lines of accountability and responsibility between the registered manager and Regal Care Homes Ltd are unclear with the registered manager appearing to take instruction from various people, which in some cases has resulted in poor outcomes and risk for residents. Examples of this include staffing levels and staff recruitment. This issue has been discussed with the responsible individual and the registered manager in relation to their responsibilities for ensuring that the Care Homes Regulations 2001 are complied with. At present the quality assurance system consists of a quality survey of relatives where letters/questionnaires are sent out every three months. These are now being returned directly to head office who will collate the information and forward to managers in the form of a report. The results of this survey had not been collated at the time of the inspection. The responsible individual carries out unannounced visits to the home each month to review standards of care and has advised that a newly appointed training officer will be visiting regularly to review standards and consider staff training needs. A sample check of monies held on behalf of residents found that money was securely stored and balances were correct. Advice was given to obtain individual receipts for clothing purchased on behalf of residents. Staff confirmed that they had received appropriate training in safe working practices. Two new staff advised that they had received a tour of fire exits and instruction in the action they should take in the event of a fire. The registered manager confirmed that all staff had received up to date movement and handling training. District Nurses recently raised some concerns about the safety of a hoist and the suitability of the slings in use for a particular resident. While the issue has now been resolved, this and the movement and handling assessments identify the need for more training in assessing and care planning in relation to residents movement and handling needs. Bed rails on two beds checked were found to be loose. This is an issue which has been raised previously, and although addressed at the time it is clearly not being monitored sufficiently to protect residents. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 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 3 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 2 2 X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP8 OP8 Regulation 12(1)(a), 13(4)(c) 12(1)(a &b),13 (1b) Requirement Pressure relieving equipment must be properly maintained according to the instructions. Residents’ care plans must include details of any pressure relieving equipment as authorised by the District Nurse and any maintenance or monitoring instructions required of staff. (This is an unmet requirement with a timescale for compliance of 06/03/06). Where authorised by the District Nurse bed rails must be safely and securely fixed at all times. Residents must receive the level of assistance they need with meals while they are still hot. There must be sufficient staff on duty at all times to meet residents’ needs. 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 DS0000012735.V288931.R01.S.doc Timescale for action 30/04/06 30/04/06 3. OP8 12(1)(a& b),13(4c) 12 (1) (a & b) 18 (1) (a) 19 (1) (b, c) 30/04/06 4. 5. 6. OP15 OP27 OP29 30/04/06 30/04/06 30/04/06 Cheney House Version 5.1 Page 26 work history. 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. Refer to Standard OP7 OP16 OP31 Good Practice Recommendations Care plans should contain specific details of the care needs and preferences of residents. The process for dealing with concerns should be improved to ensure matters are dealt with at an early stage. Clear lines of accountability should be in place between the registered manager and the organisation. Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 Cheney House DS0000012735.V288931.R01.S.doc Version 5.1 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. 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