Inspection on 08/12/08 for Cheney House

This inspection was carried out on 8th December 2008.

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

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 28/02/08

Cheney House 05/04/07

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Cheney House Rectory Lane Middleton Cheney Banbury Oxon OX17 2NZ Lead Inspector Irene Miller Unannounced Inspection 8th December 2008 09:30 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.V373430.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.V373430.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) Manager post vacant 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.V373430.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. 28th February 2008 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 are the Registered Providers of the home. The home is located in the village of Middleton Cheney and is set within its own grounds. The building was a former rectory and is a listed building. There are nineteen single bedrooms of which nine have en-suite toilet facilities. Of the eight bedrooms, which are shared by two people, two have en-suite facilities. 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 fees confirmed by the registered manager as being current at the time of this inspection range between £350 to £550 per week, the fee is dependant on whether residents are funded by the local authority or by private arrangement. The service user guide gives details on the difference in fees and how they are set dependent upon the care and support required and type of bedroom facilities 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. The homes statement of purpose and service users guide had been reviewed since the last inspection and the range of fees had been included within the service users guide. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of all inspections undertaken by the Commission for Social Care Inspection (CSCI) are based upon seeking the outcomes for people using the service and their views of the services provided. This visit was unannounced and involved two regulation inspectors we focused on the ‘key standards’ under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The care records of four people using the service were sample checked which involved looking at their individual care plans (a care plan sets out how the home aims to meet the personal, healthcare, social and spiritual needs of the people using the service), we looked at risk assessments and other care records to establish how the home works with health and social care professionals to meet the needs of the people using the service. Time was spent talking with people to establish how they view the care provided at the home and with staff to establish the support and training provided at the home. Observations of care practices and discussions with people using the service gave an indication on the quality of the service provided at Cheney House. Records in relation to the homes maintenance, management and quality assurance systems and staff recruitment and training were viewed. Two random unannounced inspection had taken place since the last key inspection and the reason for the random inspections was to monitor compliance with statutory requirements and to look at areas of concern identified through information provide to the Commission for Social Care Inspection through the safeguarding vulnerable adults process. What the service does well: Information on the aims and objectives of the home is made available to prospective people considering moving into the home. This is in the form of the homes statement of purpose and service users guide (that gives details of the services provided by the home) both documents were available within the front entrance of the home. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 6 Within one of the care plans viewed of a person diagnosed with diabetes and at risk of hypoglycaemic attacks there was good instruction for staff on the signs and symptoms of hypoglycaemia. There were records within the care plans of when people had received treatment from the district nurse and of weight losses and gains being monitored. There were records available on the pressure area care provided for frail residents who require to be turned whilst in bed, to prevent the risk of developing pressure area sores. During the inspection we observed staff treating people with respect staff were seen to respect privacy by knocking on doors before being invited to enter. Visiting relatives were observed to be made welcome by the staff and within the care plans there was records of care reviews taking place involving the person and their representatives. What has improved since the last inspection? What they could do better: The monitoring of the fluid intake for people who are identified at risk of dehydration needs to be improved. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 7 The blood sugar monitoring of people identified at risk of their diabetes being out of control needs to carried out as directed by the general practitioner and records need to be fully legible. The changing needs of people using the service need to be entered into their individual care plan without delay and the dependency assessments need to reflect these changing needs. The information within the care plans on the personal hygiene preferences must reflect their current situation for example one care plan had instruction that the person was “to be encouraged every week to have a bath “this was not possible at the time as the bathing facility was out of use. Where bedrails are introduced this must be done following a full assessment by a health care professional and full consultation with the person for whom their intended use and where this is not possible the persons representative must be consulted. Information on allergies such as penicillin needs to be brought to the attention of the general practitioner, within the care plan of one of the people we case tracked there was information that they were allergic to Penicillin and had been prescribed Amoxicillin that is a medication within the penicillin group. Further work is needed to provide a person centred approach as to how challenging behaviours such as verbal and physical aggression are to be managed. Accidents and incidents which had been identified within the safeguarding process had not been brought to the attention of CSCI through the regulation 37 notification process, it is of vital importance that the process of managing and running the home is open and transparent. That CSCI are informed of all significant events, incidents and accidents that place the health and wellbeing of people using the service at risk. Systems on how concerns and complaints are handled need to be fully reviewed to ensure that people have the opportunities to air any concerns they have and feel confident that they are being listened to and their concerns acted upon. There need to be records of all concerns and complaints, the actions and outcomes available for inspection. Only under exceptional circumstances should staff take up employment pending clearance of a CRB check, in this event the new member of staff must work under strict supervisory arrangements the employer must be able to evidence how the member of staff has been supervised. Staff induction training must ensure that all newly appointed staff are trained in the basic core induction mandatory areas for social care workers as stipulated within the General Social Care Code of Conduct GSCC guidelines. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 8 When employing staff from overseas a police check needs to have been carried out with their home country. 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.V373430.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (standard 6 is not applicable to this service) Quality in this outcome area is good. Needs are assessed prior to people moving into the home, and there is information available about the home to enable people to decide whether Cheney House can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes statement of purpose and service users guide (that gives details of the services provided by the home) was available within the front entrance of the home. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 11 Within the four care plans viewed there was records available of pre assessments having been carried out prior to people moving into the home. Records were available of assessments having been carried out by the placing authorities and the home prior to admission into the home, and these assessments had formed the basis of the care plans. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 & 10 Quality in this outcome area is adequate. The basic healthcare needs of people are being met however closer detail to monitoring the changing needs of people would ensure peoples health, safety and welfare needs are fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We visited Cheney House on 15th and 19th September to carry out unannounced random inspections the reason for these inspections was to Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 13 monitor compliance with the Care Standards Act (CSA) 2001 following concerns that had been raised through the safeguarding of vulnerable adults processes. We looked at how people’s health care needs were being met following information that someone using the service being admitted to hospital in a dehydrated condition. During the random inspection visit on 19th September we observed staff giving people an evening drink and biscuit in the lounge. Several people were already in bed and staff confirmed that these people would be given drinks in their rooms. We observed some people who were in bed in most cases they were asleep and appeared comfortably settled. At this inspection we found no evidence of anyone being dehydrated. We looked at the fluid intake for one person who was identified at risk of dehydration and found that no record of their fluid intake was being kept, considering that this person had recently been admitted to hospital due to being dehydrated. One person was subject to a safeguarding adult protection plan following concerns that their diabetes had not being appropriately managed at the home. We looked at the care records of this person who had been admitted to hospital. There was instruction that the person was at risk of hypoglycaemic attacks. There were instructions for staff on the signs and symptoms of hypoglycaemia. The protection plan had instruction that daily blood sugar monitoring was to take place and records of the person’s fluid and dietary intake were to be kept. We checked the blood sugar monitoring records over the week prior to their admission to hospital, we found one of the entries was not legible and two consecutive days had passed where no blood sugar record had been entered. The person had developed warning signs of a hypoglycaemic attack ‘shivering, vomiting, high temperature’ and was consequently admitted to hospital. There were records within the care plan of the person having been seen by their general practitioner prior to their admission into hospital and of their diabetic medication having been reviewed. This person who had been also been admitted to hospital following a fall which had resulted in sustaining a head injury, the mobility assessment for this person had been recently reviewed and stated that the person was fully independent and that there were ‘no difficulties with their mobility’. We spoke with staff who said that recently this person had become increasingly unsteady on their feet, we looked at the accident reports and found that this person had sustained three falls within a one month period one of the reports stated that Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 14 the person was ‘too weak to stand’. Two of the falls had resulted in injury and consequently their admission to hospital for further tests. Within the care plan for one person there was a ‘consent to use bedside rails’ form that had been signed by the persons relative in May 08, the bedside rails had been fitted due to the person being at risk of falling out of bed. We looked at records of accident reports for this person and found that in June 08 they had climbed over the bedrail and a decision had been made to have them removed, however the person sustained another fall from bed in August 08 and the bedrails were reintroduced. There was no documentation within the care plan to evidence that the person or their representative had given consent to the bedrails being refitted to the bed. Within the accident reports there was a record that in October 08 the person had again climbed over the bedrails. We spoke with the registered person as to the suitability of using bedrails for this person. The registered person stated that the district nurse carries out the bedrails risk assessment and that it was considered that the person was at greater risk of falling from bed without having bedside rails in place. The care plan for this person stated that the assessment was available within the ‘district nurse notes’ we looked at these notes and found that there was no documentation available to confirm this agreement. Failure to determine the suitability of bed rails for an individual can place people at increased risk of injury. A new care plan had been put into place and the person’s daily needs had been reassessed following the fall in October 08. During the random inspection of 15th September 08 we looked at the Bathing provisions for people using the service, this was due to the home having not been able to establish at the last key inspection when one of the bath hoist on the ground floor was last serviced. We were very concerned to find at the random inspection that the bath hoist was condemned unfit for purpose in April 08. During the random inspection the registered manager confirmed that bathing facilities had already been inadequate and insufficient. That this bath and bath hoist had apparently been the only one in use for all people using the service prior to April 2008. In September 08 we issued an ‘urgent action’ requirement that bathing facilities must be provided that meet the needs of people who use the service. At this inspection we found that a new bath hoist had been fitted and within the care plans viewed the bathing preferences of people were recorded. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 15 There were records of people having access to Chiropody services, however within one of the care plans viewed the record of chiropody visits were vague the care plan stated that the person needs chiropody every 6 – 8 weeks the last entry of having been seen by the chiropodist was in September 08 a time frame of approximately 9 weeks. In discussion with the registered person it was confirmed that no formal arrangement was in place to forward plan chiropody visits for individuals. We looked at the medication storage and administration systems to include controlled drugs in use there was evidenced that these were stored safely and accurate records were being kept. During the random inspection visit on the evening of 19th September 2008 We observed one person asleep in their room there was a medication pot containing the person’s medication left on the bedside table. This was brought to the attention of the senior carer on duty at the time. There was evidence that referrals had been made to the General Practitioner where people were unwell and records showed that where antibiotics had been prescribed these had been obtained and were being given according to the prescription. However within one of the care plans viewed there was instruction that the person was allergic to Penicillin we looked at the prescribed medications for this person and found that they had been prescribed Amoxicillin that is a medication within the penicillin group. During the visit we spoke with a visiting district nurse, we asked what their views were on how the home meets the heath care needs of people. There was some concern expressed over the number of people acquiring skin tears to legs and that this may be due to poor moving and handling techniques e.g. people catching their legs on wheelchair footplates. The district nurse said that training had been offered to the home in the form of short workshops for staff on wound care and tissue viability and that there had been a poor response from the home on taking up this offer. There were records within the care plans of when residents had received treatment from the district nurse and of resident’s weights being monitored, to identify weight gains and losses. There were records available on the pressure area care provided for frail residents who require to be turned whilst in bed, to prevent the risk of developing pressure area sores. During the inspection we observed care practices, staff were seen to knock on doors before entering and to treat people with respect. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 16 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): Standards 12,13,14 & 15 Quality in this outcome area is good. Generally people are able to exercise choice and control over their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the random inspection of 15th we were concerned that the wishes of a person were not being respected in relation to their bedtime routine, it was felt that the person had the capacity to make her own decisions and we gave advice about people’s rights and the need to listen to people and take account of their individual preferences, concerns and routines. Within the care plans viewed each had instructions on the persons life history, which was available in written and pictorial formats. The home cares for people with a diagnosis of dementia and within the care plan of one person diagnosed with Alzheimer’s disease a form of dementia there was basic instruction for staff on defusing potentially volatile situations. There was instruction that the person ‘can be physically and verbally aggressive’ that they ‘can shout when upset’, the action identified to defuse Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 17 this behaviour was for staff to ‘try to calm the person down to talk in a quiet area and offer tea’. There was no instruction as to what the possible triggers may be to the person becoming aggressive. Visiting relatives were observed to be made welcome by the staff and within the care plans there was records of care reviews taking place involving the person and their representatives. There was information within the care plans on the residents food preferences and gave details where residents may have difficulties with eating and drinking such as soft diets and foods that needed to be cut into small pieces. One person was heard to ask a member of staff what was for lunch, the member of staff said “I don’t know, I think it might be fish and broccoli” People were observed receiving the lunchtime meal which was Pork Casserole one person was observed receiving their meal that required to be fed by a member of staff, the person was heard to ask the member of staff ‘what have we got today?” the member of staff said ‘Pork Casserole’ the person said “I don’t like Pork” the member of staff said “lets try it” the person responded by saying “I can’t chew you rotten mare”. This person went on to say “I don’t like carrots” and pushed the fork away from their mouth. In discussion with the member of staff they said that this was usual behaviour for this person. Many of the people using the service require staff assistance to eat their meals, we observed one person being fed by a member of staff who was standing up beside them, the registered person entered the room and noticed this inappropriate way of assisting people with their meal and took immediate action to ensure the person was assisted in a dignified way. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is adequate. Inadequate recording of concerns and complaints places people at risk of their concerns and complaints not being taken seriously and acted upon, and inadequate recording of staff recruitment procedures place people at risk of not being protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection visit we had received information that had raised concerns about the care of people using the service that had resulted in CSCI raising alerting social services through safeguarding adult procedures. It was of particular concern that accidents and incidents which had been identified within the safeguarding process had not been brought to the attention of CSCI through the regulation 37 notification process, it is of vital importance that the process of managing and running the home is open and transparent. That CSCI are informed of all significant incidents and accidents that place the health and wellbeing of people at risk. We asked to see records of complaints held at the home, the complaints book provide had pages torn out of it, one concerns was entered in this book in November 2008 there was no record of any investigation or outcome having Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 19 taken place. In discussion with the operations manager she confirmed verbally that an investigation had taken place and took steps to have this recorded within the complaints book. We were concerned that the use of a complaints book did not comply with the data protection act in provide privacy for the complainant. Whilst sample checking staff recruitment files we found that a member of staff had commenced employment pending clearance through the Criminal Records Bureau (CRB). There was no evidence to establish the close supervisory arrangements for this member of staff as the staff rota covering the period 20th October 2008 could not be produced. On checking records of staff training there was evidence that most staff had been provided with training on the Protection of Vulnerable Adults (POVA) Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21 & 26 Quality in this outcome area is good. People using the service are provided with a home that is warm and safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A limited tour of the building was conducted which included viewing the communal areas, sample checking of bedrooms and the kitchen and laundry facilities. At the last key inspection we identified that one of the bath hoists did not have an annual service report available and the service label on this piece of equipment had become worn and no longer legible to read. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 21 During the random unannounced visit of 15th September 08 we again looked at the provision of lifting equipment, the service report for the bath hoist was available and evidenced that a service had been carried out in April 2008. However this service report had identified that the hoist was unsafe to be used. The Registered Manager advised at the time that the hoist could not be repaired due to its age, as the parts were obsolete. Due to this piece f equipment being out of use had resulted in people being without assisted bathing provision since April 2008. It transpired that the bathing facilities had already been inadequate and insufficient. The bath and bath hoist had apparently been the only one in use for all thirty four people prior to April 2008. A small number of people were using a domestic type shower, however as this required people to have the ability to step into it, the needs of the majority of people were not being met. We sample checked the bathing needs of people through the written information within their care plans we found that no risk assessment or changes to peoples care plans had taken place due to the lack of assisted bathing provision. For example one care plan, which had been reviewed in September 08, had instructions that the person was “to be encouraged every week to have a bath “this was obviously not possible as the bathing facility was out of use. During the visit of 15th September 08 we found that there was portable hoist in use which had passed the next service due date, this was brought to the attention of the registered manager during the inspection. We checked this piece of equipment at this key inspection and found that a service had taken place and the equipment was fit for use, in addition another portable hoist had been purchased by the home. When we visited on 15th and 19th September 08 we found that there was an exceptionally strong unpleasant odour, which was noted immediately on entering the building. This odour was evident throughout the corridors and the lounge. At this key inspection we were pleased to find that action had been taken to improve the environment new washable non-slip flooring has been fitted to the main lounge and to the first floor corridors and there was no unpleasant odour detected within the communal areas of the home. At the random Unannounced visit of 15th September 08 we found that the conservatory required work to a leak in the roof at this key inspection visit there was evidence that some work had taken place to carry out repairs, and new flooring had been fitted and radiator covers fitted. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 22 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): Standards 27,28,29 & 30 Quality in this outcome area is adequate. People using the service are cared for by a team of staff that are generally aware of their needs, however shortfalls in training not always being provided upon employment and the carrying out full staff recruitment checks has the potential to place people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the recruitment files of three staff recently employed at the home, within one of the files viewed we noted that the Criminal Records Bureau (CRB) clearance had been obtained almost five weeks after their start date. There was no evidence to show the close supervisory arrangements that need to be followed when staff take up employment pending their CRB clearance, we asked to se the staff rota for this period however this was unable to be produced at the time of inspection. We looked at records of staff induction training and one of the files could only evidence that the first day induction had been completed which included instruction on Moving and Handling, and Fire Awareness there were no other records within this file of the member of staff having been provided with any other training since taking up employment at the home. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 23 We looked at the recruitment file of an overseas member of staff within their pre employment checks there was no evidence that a police check had been carried out from their home country. There was evidence that this member of staff had been provided with Health and Safety training, and Protection of Vulnerable Adults (POVA) training, however there were no records of having undertaken the standard induction training. This person held the responsibility of administering medication there was no record of having been provided with medication training, however in discussion with the member of staff they confirmed that they had embarked on a distance learning medication training course provided by the home through a local college. During the random inspection of 15th September08 we looked at a sample of staff training records there was evidence that the majority of staff had received movement and handling training from a qualified trainer. On the day of this key inspection the staffing levels appeared adequate to meet the needs of the current people using the service. Cheney House DS0000012735.V373430.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): Standards 31,33,35 & 38 Quality in this outcome area is adequate. The process of managing and running the home needs to be open and transparent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the random inspection of 19th September 08 the registered manager has left employment at this service, a new manager has been employed who has experience of managing services for older people. The new manager had been in employment for approximately three weeks and had commenced work on reviewing the care plans and risk assessments. Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 25 We would expect that the new manager submit her application to register with CSCI without delay. We are concerned that we are not in receipt of Regulation 37 notifications for accidents and incidents that have placed people using the service at significant risk of their health and welfare needs not being met. Monthly unannounced regulation 26 visits take place and on viewing these records there were areas that would have constituted CSCI being kept informed for example the lack of bathing provision, accidents and illnesses resulting in hospitalisation. We checked records of satisfaction surveys during the random inspection visit of 15th September 08 and since this inspection additional quality assurance processes have been implemented these consist of audits that take place every three months and cover areas such as medication management and care planning. Records of the money held on behalf of residents were sample checked and were seen to be satisfactorily managed. Cheney House DS0000012735.V373430.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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 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 2 17 X 18 2 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14 (2) (a) (b) 15 (2) (b) Requirement The changing needs of people using the service must be entered into their individual care plan without delay and dependency assessments kept under review to reflect the changing needs. This is to ensure that the care provided is appropriate to the needs of the people using the service. 2 OP8 13 (4) (c) People identified at risk of 11/03/09 dehydration must have their fluid intake monitored and recorded. This is to ensure the risk of dehydration so far as possible eliminated. 3 OP8 13 (4) (c) The blood sugar monitoring of people identified at risk of their diabetes being out of control must be carried out as directed by the general practitioner and records need to be fully legible. This is to identify and so far as possible keep blood sugar levels Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 28 Timescale for action 11/03/09 11/03/09 under control. 4 OP8 15 (2) (b) The personal hygiene preferences of people recorded within the care plan must reflect their current situation. This is to ensure that their personal hygiene needs can be fully met. 5 OP16 22 (3) All concerns and complaints must be recorded and the actions and outcomes recorded. This is to ensure that complaints are fully investigated. 6 OP18 19 Schedule 2 Only under exceptional circumstances must staff take up employment pending clearance of a CRB check, in this event the new member of staff must work under strict supervisory arrangements the employer must be able to evidence how the member of staff has been supervised. This is to ensure that people using the service are protected from abuse. 7 OP29 19 Schedule 2 Police checks must be carried out 11/03/09 for staff employed from overseas with their home country. This is to ensure that people using the service are protected from abuse. 8 OP30 18 (c) (i) (ii) Newly appointed staff must be provided with induction training within six weeks of appointment to their post. This is to ensure that all staff are trained in the principles of care, Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 29 11/03/09 11/03/09 11/03/09 11/03/09 safe working practices, the organisation and worker role and the particular needs of the people using the service. 9 OP38 13 (4) (a) Full assessments for the use of 11/03/09 bedrails must be in place and the suitability of the bedrails must be regularly reviewed in consultation with the person and healthcare professionals involved with their care. This is to ensure they are used appropriately and reduce the risk of injury or entrapment. 10 OP38 37 (1) (a - g) (2) The Commission for Social Care Inspection (CSCI) must be informed in writing of all significant events, incidents and accidents that may place the health and wellbeing of people using the service at risk. 11/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations Information on allergies such as penicillin should also be recorded on the person’s medication record and brought to attention of the general practitioner responsible for prescribing medications. Detail within the care plans on managing challenging behaviour should use a person centred approach. The new manager should submit her application to register with CSCI without delay. 2 3 OP7 OP31 Cheney House DS0000012735.V373430.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V373430.R01.S.doc Version 5.2 Page 31 - 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. 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