Inspection on 19/08/08 for Cheneys

This inspection was carried out on 19th August 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

Cheneys 03/10/07

Cheneys 26/10/06

Cheneys 19/12/05

Cheneys 24/05/05

Cheneys 26/10/04

Cheneys 24/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Cheneys Links Road Seaford East Sussex BN25 4HY Lead Inspector Michele Etherton Unannounced Inspection 19th August 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 Cheneys DS0000028541.V370587.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. Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheneys Address Links Road Seaford East Sussex BN25 4HY 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) 01323 893373 01323 491480 cheneys@btconnect.com www.sxhousing.org.uk Sussex Housing and Care Manager post vacant Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is fiftyone (51). Service users must be older people aged sixty-five (65) years or over on admission. Up to a maximum of thirty-three (33) service users may be in receipt of nursing care. 3rd October 2007 Date of last inspection Brief Description of the Service: Cheney’s is situated in a quiet residential area of Seaford a short walk from the seafront and approximately half a mile from the town centre with its access to bus and rail routes. The home is registered to accommodate up to 54 older people, 33 of whom may be in receipt of nursing care. The registered owners are Sussex Housing and Care. The home is part purpose built and part converted with accommodation over two floors. The home comprises of 48 single bedrooms (26 of which have ensuite facilities) and 3 double bedrooms (all 3 of which have en-suite facilities). There are additional toilet and bathroom facilities throughout the home. Rooms are located over two floors, accessible by two passenger shaft lifts. The home has a number of specialist equipment in use such as mobility aids, specialist nursing beds and bath and moving/handling hoists. There are extensive attractive gardens to the rear of the property that are accessible to residents. There are car-parking facilities to the front of the premises. Potential new service users can obtain information relating to the home via the internet, CSCI Inspection Reports, Care Managers, Placing Authorities, by word of mouth and by contacting the home direct. The range of fees charged (at the time of this report) is £345 - £660 per week, with additional charges made for newspapers, hairdressing, toiletries and chiropody. Cheneys DS0000028541.V370587.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. A key unannounced inspection of this service has been undertaken, this has taken account of information received from the service and about the service by CSCI since the last inspection, including an Annual quality assurance assessment (AQAA) completed by the manager and information relating to an adult safeguarding alert during and subsequent to the site visit. The AQAA has been completed to a reasonable standard and provides us with most of the information we need, there are some areas where more supporting evidence would have been useful to illustrate what actions the home has taken to address previously identified shortfalls. The inspection includes an unannounced site visit to the home on 19/8/08 during which a tour of the premises was undertaken. The manager, care and ancillary staff consulted with in addition to a selection of residents. The views and comments received during the site visit and from survey responses have been influential in the compilation of this report. All key standards have been inspected some in more depth than others; Standards where outstanding requirements have been issued previously or outcomes became apparent during the site visit have also been included. A range of documentation has also been examined including care plans, risk assessments, menus, Medication administration records, staff recruitment, training and supervision records, complaints and accident reports. What the service does well: The home provides a safe comfortable environment that is maintained to a good standard of cleanliness and decoration. Residents told us they liked the fact that the home has no unpleasant odours. Residents spoke positively about the home and their experiences of it; they like the staff and find them friendly and kind. Residents like the quality of the meals they receive and feel comfortable talking with the chef about menu’s and meal choices. Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 6 Residents told us that they like the range and frequency of the activities provided for them. Residents like the large well-kept grounds. Resident’s benefit from having enough staff on duty to support them, use of agency staffing and staff turnover has reduced providing greater continuity for residents. The staff team are well trained, and demonstrate commitment to their role. Staff feedback indicates that relationships and communication within the staff team is good. A staffing structure has now been established and the management team operate an open door style of management valued by staff. Staff and residents told us that feel able to express their views and ideas and that action is taken. The home listens to residents and keeps them informed of changes Systems are in place to ensure prospective residents are assessed before moving in and needs are kept under review to ensure residents can continue to receive the support they need. The home routines promote and encourage independence amongst residents and the opportunities to make choices and decisions for themselves on a dayto-day basis. Residents who are able to continue to manage their own medication and finances, The home is welcoming to visitors. Residents told us that: Cheney’s has a happy atmosphere young staff are always laughing and joking with residents they do so much to remove the “home “ atmosphere, no one sits in a ring staring vacantly into space there is not a nursing home smell” “Cheney’s is a first class home providing first class care to all residents I can say that the staff are very considerate and caring and I have no reservations about the care supplied” What has improved since the last inspection? Since the last inspection the home has experienced a period of instability following the departure of the manager, a new manager is now in post and a clear staff structure providing lines of accountability developed. The home has addressed all but one previous outstanding inspection requirements, evidence from records viewed and discussion with RGN staff indicates that action was taken to address what they thought was the Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 7 requirement, unfortunately this had been misunderstood and the identified shortfall has not been addressed, we have taken a proportionate view of this that this omission had not been intentional and a clear commitment to address the requirement has been made, in this instance we have reworded the requirement to make clear to staff what is required of them. A rolling programme of staff training has been established to ensure mandatory and more specialist training is provided to staff. The assessment process for new residents has been improved. Increases to RGN (Registered general Nurse) staffing levels have enabled the home to improve medication administration times. Improvements have been made to the detail within resident support plans and this is an ongoing process with more person centred plans to be implemented. A nutritional assessment tool has been introduced for new residents’ that is reviewed. External agency pharmaceutical audits have been implemented. A programme of redecoration is underway with ground and first floor corridor areas and some bedrooms being upgraded. What they could do better: The home has identified within AQAA information areas where they consider further improvement is still needed. During the site visit we found a number of areas where the service provides positive outcomes for service users as well as a small number of areas, where Standards are either not being sustained or would benefit from improvements to current practice. Although medication arrangements are much improved some shortfalls remain that should be addressed to ensure residents are safeguarded by good practice at all times. A recent adult safeguarding alert has highlighted serious shortfalls in management and staff awareness and understanding of their responsibilities and duties under whistle blowing and adult safeguarding, and relevant agencies have not been alerted as required by legislation and guidance. The recruitment procedure has the potential to be robust but has not been applied consistently leading to shortfalls in the level of vetting and checks undertaken on new staff and thereby placing residents at risk. Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 8 The home is still to develop a system for quality review of its service that evidences the involvement of residents in influencing service development and which the home produces a report annually of its findings. The provider has failed to ensure that the responsible individual is undertaking visits to the home in accordance with regulation 26 to ensure the home is running well and engage with residents and staff to gauge their views. Recommendations for improved practice have also been issued in respect of: meeting the needs of visually and hearing impaired residents, recording in daily records, and complaints information, improvements to the quality of individual risk assessment information, the provision of induction and mandatory training for staff within timescales and in keeping with current practice, the frequency of staff supervision and participation by night carers in fire drills. It is also recommended that the manager seek advice from the infection control team regarding the use of a 1st floor toilet without hand washing facilities. 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. Cheneys DS0000028541.V370587.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 Cheneys DS0000028541.V370587.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): 1, 3, 4,6, People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. New residents have access to information about the home and have opportunities to visit and experience on a trial basis what it might be like to live there. Prospective residents can be assured that their care and support needs are assessed prior to admission to ensure these can be met, however, those with profound visual and hearing impairments would benefit from improved adaptations in the home to aid their full integration and maintain independence. Intermediate care is not provided at this time. EVIDENCE: Survey responses indicate residents feel they had enough information from the home, from relatives, from previous knowledge about the service to inform their decision to move in. The home has told us in their Annual Quality Assurance Assessment (AQAA) information that they have updated their user Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 11 guide information and agreed at the inspection to ensure that all prospective residents receive a copy of the terms and conditions they will be asked to sign with the guide to aid their decision making. Residents told us that they feel listened to and that their views are taken account of and were able to give examples where this has happened, whilst systems exist within Sussex Housing and Care for Residents views to be sought as part of a quality assurance measure this has not been routinely implemented within Cheneys within the last 12 months and consequently updated user views have not been incorporated into the user guide, and we recommend that this is implemented once the quality assurance system is fully operational. Five resident files were examined and evidenced that more recent admissions to the home now receive a detailed assessment of need prior to admission. A more comprehensive assessment tool is also now under consideration to help gather more information particularly for nursing clients, the home manager is aware of the need to ensure that if adopted it also meets the needs of non nursing residents. The home has told us within its AQAA information that 11 residents have visual impairments with two being registered Blind, there are also a number of people with hearing loss in different stages, several profoundly. At present no specialist facilities are available for these residents in that familiarisation with the building and important locations e.g. toilets, dining room and lounges are not highlighted by tactile markers or colour coding for less severely visually impaired people or other means of orienting visually impaired people to their home without reducing their independence. We spoke to those registered blind residents who said they had familiarised themselves with the building and were satisfied with the support they receive but in one case recognised that for some people these additional measures would be helpful in settling in. The home does not at present offer a loop system for hearing impaired residents and flashing lights are not in place to enable residents to be aware of knocks on doors etc, if the home is to continue to offer support to people with profound visual and hearing impairments they will need to consider the implementation of such facilities to fully meet needs and this is a recommendation, this will also mean looking more closely at documentation and information being available in different formats. An Intermediate Care service is not offered although the home is able to offer periods of respite care when long term vacancies arise and are unfilled for a short period. Cheneys DS0000028541.V370587.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): 7,8,9,10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements to the content of care plans have made them more reflective of what support and care is to be delivered. A risk assessment strategy is in place to safeguard residents but some assessments would benefit from being more individualised. Medication arrangements are generally good but would benefit from suggested improvements. Home practices and staff attitudes promote respect dignity and the privacy of residents. EVIDENCE: We examined a sample of five resident files, the content has been revised with clear evidence of updating and reviewing, the level of detail within care plans is more reflective of individual routines but the home management recognise this could be further improved and be more person centred and this was particularly highlighted by a visually impaired resident who told us that whilst they were generally very happy with the support they received from staff it is Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 13 really important in maintaining their independence and orientation within their own space that staff do not move objects or items from their position and this was not sufficiently made clear within care plan information to inform staff. A review of one care plan highlighted the need for staff to be cautious about attaching diagnosis e.g. mental health to residents displaying behaviour where there is no clinical diagnosis or supporting evidence. Appropriate guidelines for staff responses to verbal aggression from some residents are in place. Care plans examined provided evidence of health contacts and a staff member reported that one of the things they liked about the home when they worked as an agency worker was the insistence on referrals to GPs as soon as residents became unwell. All residents spoken with and responses from survey feedback indicates that they feel well cared for and that staff understand their needs and support them in a way they are happy with. Cheney’s has a happy atmosphere young staff are always laughing and joking with residents they do so much to remove the “home “ atmosphere, no one sits in a ring staring vacantly into space there is not a nursing home smell” “Cheney’s is a first class home providing first class care to all residents I can say that the staff are very considerate and caring and I have no reservations about the care supplied” The home is monitoring fluid intake for those where an issue has been identified, turning charts are in place and weights recorded regularly. RGN’s have identified a need for a hoist with a weighing facility and this has been ordered. Assessment of nutritional risks and monitoring of food intake is also undertaken for those residents who are deemed at a higher risk, as are systems for management pressure care. Residents told us that they are consulted about their care and in records examined there is evidence that some residents have signed agreement to their plan of care and this should be progressed for everyone with capacity to do so. The manager was reminded to familiarise herself with the mental capacity Act to ensure the home is acting appropriately with regard to authorisations for residents treatment and care, other than by the resident themselves. The quality of daily recording by staff has improved and guidelines introduced to inform staff how to complete daily entries, some examples viewed indicated this is not always being adhered to and failings in this area should be addressed with relevant individuals through supervision, and is a recommendation. In response to a previous recommendation the manager is currently engaged in developing a pain management tool to incorporate within care plans and it is further recommended that this is now progressed and implemented. Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 14 A risk assessment strategy is in place and records examined evidenced both environmental and individual resident risk assessments, there has been a practice of adapting general risk assessments in respect of e.g. bed rails, falls, hot liquids for individual residents where these risks exist, these have not been completed to a good standard overall and it is recommended that risk assessments are made more individual taking full account of the specific needs of the resident and are not an “add on” to a more general format. The home has told us in their AQAA information and from discussion with the manager that their medication arrangements have been assessed recently by an external agency OPUS as excellent, they also receive regular visits by the local pharmacist to assess medication practices, we spoke with an RGN on duty who expressed a view that since the last inspection there had been a significant improvement in the management of medication, we looked at medication storage, administration and recording some in more depth than others to ensure that previous requirements had been addressed. We found that medication storage is good and medication audits are being implemented, only RGN staff administer medication and hold the keys to medication cabinets. One resident we spoke to expressed concern at the poor spoken English of some administering staff and residents ability to understand important information about their medication, the manager has indicated that identified staff are to be provided with additional support to develop their spoken English. A medication round was partly observed and administration practice generally satisfactory, one small incident was observed, this was not serious but reported to the senior RGN on duty to discuss with the staff member concerned to improve practice. Recording of medication has improved, a sample of MAR sheets have been examined, these evidenced no omissions in recording and appropriate use of codes, handwritten changes on MAR sheets are being dated in the majority of cases but not signed for, the use of sticky pharmacist labels on MAR sheets should also be discouraged owing to the possibility of errors occurring through overlapping or removal. A previous requirement in respect of PRN medication has been misunderstood by staff who have spent time developing documentation in another area, although this will be helpful to them and they have demonstrated a clear intention to address this requirement we have taken a proportional view and will require the home to address this and other shortfalls highlighted. There is evidence on MAR sheets of the receipt of medication and a returns book is in place, stock recording is being undertaken on the MAR sheets but, Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 15 care needs to be taken in recording entries neatly. Creams and lotions are kept in individual resident rooms and records of their administration. The home encourages self-medication and capacity assessments are undertaken routinely to inform decisions around this, disclaimers are also in place for self-administration. Residents told us about the importance of maintaining responsibility for their medications and others indicated they did not self medicate by choice. Residents told us through survey feedback and direct interviews that they are content with living in the home, and speak highly of the attitudes and care support they receive from staff. Cheneys DS0000028541.V370587.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): 12,13,14,15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents enjoy an improved range of social and recreational activities, and live the lifestyle they choose within the home and are encouraged to maintain their independence. Families and visitors are made welcome. Residents are provided with a varied and nutritious diet that provides opportunities for exercising choice and about which they are consulted. EVIDENCE: Feedback through resident surveys and interviews indicate that on the whole residents enjoy the activities provided and in some instances would like to see more, at present they would seem to have at least three activities per week in addition to bingo, residents we spoke to thought they would like to have an activity at least three or four times per week, some individual comments about the frequency and range of activities have been made to us these are: “Taking part in all activities” Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 17 “It would be nice if there were more short outings from Cheney’s” “The most brilliant innovation has been introduced twice per week keyboard players play rock and roll sing along’s interspersed with jokes, residents look forward to this for an hour they feel normal” A resident reported that they would prefer clothes selling companies to not set up in main resident areas but for this to be an active choice by residents to go to an area where clothes were being offered for sale rather than feel pressured whilst sitting in the lounge. Only two responses to surveys indicated that the range of activities on offer were not satisfactory for those individuals, most residents we spoke to and who sent in survey responses expressed satisfaction with the range and frequency of activities although there is a need for activity planning to take into account the needs of visually and hearing impaired residents if they are to feel included, and also consider some of the activities that could be offered to those residents who are mostly confined to their bed rooms. Residents told us they found staff friendly and willing, the atmosphere in the home when we visited was light-hearted with lots of joking and laughter noted amongst residents and between residents and staff. A number of residents told us that they undertake their own personal care when they can although sometimes they don’t always feel up to it, this is reflected in care plans viewed, residents told us that they do what they please and fill there time as they wish, several indicated that they go out of the home with relatives and one reported they could still go out on their own but chose not to, residents advised us that they have keys to their rooms but choose not to lock them, the home may wish to revise this in the light of the recent thefts. Most residents we spoke to and heard from expressed a good level of satisfaction about the range and quality of meals they receive, the chef told us that he takes time to talk with residents about menu choices and their views of meals offered, residents confirmed they feel able to make comments and suggestions to him, and that they can have alternatives to the main meal, a fish and salad option is offered for each main meal selection. Drinks and squashes are available throughout the day and water machines are also located in the home. Staff’ are on hand to support residents during the lunch period or with eating their meal. The dining room overlooks the rear garden. Tables are laid with tablecloths and napkins and one resident commented positively about the replacement of napkins daily, as this was not experienced in other homes they had known. Condiments and sauces were noted on tables. Portion sizes were observed to be good, and residents were heard discussing the fact they could ask for smaller or larger portions. “ Nice meals provided by the home” Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 18 “Our chef is always prepared to adapt meals whenever a resident needs” Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 19 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents feel listened to and feel that any concerns they have will be acted upon. Management and staff have received training in adult safeguarding and whistle blowing but have failed to fulfil their full reporting responsibilities under this and other legislation to ensure residents have not been placed at risk, on a day to day basis the health and safety of residents is generally satisfactory but significant shortfalls in the recruitment of appropriate staff, their supervision and the management of safeguarding issues fails to promote and protect their safety. EVIDENCE: The AQAA tells us that 9 complaints have been received and addressed within the last 12 months by the home and one adult alert that the manager advises is now closed. Survey and interview feedback indicates residents understand how to make a complaint and feel able to do so. The complaints log has been examined this evidences that an index of complaints is maintained and complaints documentation is kept within this log. Whilst there is evidence of investigation and action being taken by the home outcomes are not always clear nor referral to adult protection, it is recommended that the manager Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 20 make clear final outcomes of complaint and whether complainants are satisfied or not with the outcome. The majority of staff who returned survey responses told us that they knew what to do in the event of a resident or relative expressing a concern and the staff training matrix confirms that the majority of staff have undertaken POVA training, and staff we spoke with reaffirmed this. There is currently an open adult protection alert following a series of thefts from residents and staff at the home, whilst it is likely that the resulting investigation involving the police has been concluded and a perpetrator identified the alert remains open until a full resolution has been attained. Whilst the home were quick to alert the police regarding the thefts contact with adult safeguarding and CSCI has not been managed appropriately or in line with adult safeguarding protocols and responsibilities to report under Care Homes regulations. The Adult safeguarding alert has highlighted serious concerns in respect of significant underreporting of such incidents by senior staff to the relevant agencies, that the security of the premises at night may have been compromised from time to time and failings in the recruitment of staff may also have been a contributing factor with residents and their effects placed at risk as a result. The home has revised its adult protection policy, however significant shortfalls exist in both staff and management understanding of their reporting responsibilities under both whistle blowing and adult safeguarding and a requirement has been issued for them to familiarise themselves again with these. Additionally the home is required to ensure that any event covered by regulation 37 of the care homes regulations 2001 is notified to CSCI within 24 hrs of its occurrence and where this constitutes an adult safeguarding issue that this is also reported without delay to the adult safeguarding representatives, and the police where a criminal offence may have occurred. Residents told us they feel physically safe in the home and protected that they like staff being around and someone looking in on them at night. Systems are in place to protect monies held by the home on behalf of residents, but clearly where residents choose to hold sums of money and credit cards in their own rooms the home has not provided a safe environment for them to do so or encouraged residents to lock bedrooms or keep personal items secure. Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 21 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, 21,22,24,26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean comfortable well maintained home they are encouraged to personalise their own space, and have access to a range of equipment to support their care this should be expanded to support those with visual and hearing impairments better. Attention should be given to upgrading one toilet facility to ensure good hand washing is promoted EVIDENCE: A tour of the premises highlighted that the home is generally maintained to a good standard of cleanliness, domestic staff were observed undertaking cleaning, laundry and cooking activities. Residents confirmed they are able to bring in items of their own and felt this was important in making them feel Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 22 more at home, rooms are individually furnished and reflect the range of possessions and interest each resident has. Some residents we spoke with confirmed they have keys to their bedrooms but choose not to use them. The home would benefit from re-decoration in some areas and the AQAA tells us that a programme of upgrading is already underway, staff surveys commented that the alarm call bell system is in need of attention and also that the home would benefit from improved shower facilities on the first floor, staff have repeated these suggestions in staff meetings and plans are in hand to implement. Generally toilet and wash facilities are satisfactory but one toilet on the first floor has no means of hand washing and no hand gel is in it is recommended that the manager consult with the infection control nurses as to how they can safely promote good infection control for residents without losing the use of this facility. Staff’ have also reported in survey feedback the need for additional hoist equipment, the manager and an RGN told us that this is already on order and will incorporate weighing scales. Generally nursing staff’ are satisfied with the equipment now in place to support residents and felt confident that additional equipment will be provided if needed. There is a need for the home to introduce adaptations and aids for the benefit of residents with hearing and visual impairments, whilst those currently in the home with those needs felt satisfied with the level of support available to them for those people who may have lived with these conditions for many years there is an expectation that the home would provide them to maintain the level of independence they have already attained. No unpleasant odours were noted during a tour of the premises and residents have told us in survey and interview feedback that the lack of odour is something they are pleased about. The home is maintained to a good standard of cleanliness, and staff are provided with equipment to aid infection control when undertaking personal care and managing soiled laundry, residents commented positively on the laundry service in particular. Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ are supported by enough staff’ they benefit from improvements to the range and frequency of training available to staff although shortfalls in the consistency and content of induction and the timeliness of completion of mandatory training need to be addressed. Shortfalls in the recruitment procedure to assess the fitness of staff could place residents at risk. EVIDENCE: Feedback from residents and staff through surveys highlighted no concerns as to availability of staff and staffing levels generally. At the site visit the manager confirmed that since the last inspection the management of the home has now stabilised and staffing levels have increased to ensure two RGNs are on morning and afternoon shifts in addition to nine care staff in the morning and eight carers in the afternoon. One RGN and four care staff cover night shifts. Residents told us that they don’t have to wait long for someone to come and that they thought there are the right amount of staff around at present, one staff member thought that they would like more time within each shift to talk and chat with residents however this is often difficult to achieve because of Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 24 other commitments on time. The AQAA tells us that the home has made significant progress in the NVQ training of staff with 95 having achieved or currently completing a course, unfortunately, owing to the lack of awareness and action by staff in promoting and protecting residents or their effects over the past year through implementation of whistle blowing or adult safeguarding we do not consider an excellent rating is warranted in this instance for this standard. A review of four staff recruitment files indicated that whilst the recruitment procedure has the potential to be robust with some files evidencing interview notes and role specific interview questions, these measures along with the necessary fitness checks are not being applied consistently. Files lacked evidence that applicants are quizzed about gaps in employment histories and asked to verify reasons for leaving former care roles or settings, other shortfalls noted are: one file lacked an application form or any information about previous employment or experience, another lacked both references although a CRB/ POVA is in place, another contained only one reference. The home is required within the timescale given at the end of the report to ensure all staff files contain the appropriate range of documentation required under legislation. It is acknowledged that the home has experienced an unsettled period of management and that this may have been a factor in poor recruitment practice remaining undetected, a lack of clarity between the home management and head office as to whose responsibility it is to ensure recruitment files contain all relevant information also needs to be made clear to all parties. The home has not recruited new staff since the last inspection and has done well to reduce the level of agency staffing used. It is apparent from those files viewed that induction of staff is not in keeping with common induction standards for care staff nor where staff have clearly attained a higher level of training and experience is there a record of orientation or competency assessment to ensure they have the necessary basic skills, this was discussed with the manager who has agreed to implement skills for care common induction standards for all new staff, a requirement has not been issued although the home is recommended to ensure they do progress this as agreed. There is a staff training programme in place and RGN staff indicated that professional training for themselves has improved with more frequent access to specialist courses relevant for their roles. A mandatory training programme is in place but it is noticeable that for some staff who have been in post more than one year they have still not achieved all mandatory training e.g. first aid, the manager reported that a first aid course has been booked for September and all staff without this will be attending. The home has been proactive in providing training to ancillary staff in mandatory core skills too and are to be commended for this, it is clear that some of the existing shortfalls have occurred owing to the lack of continuity in management and the new manager Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 25 has done well to get training on track, in this instance a requirement has not been issued as systems to ensure training is provided are in place but it is recommended that the home ensure all mandatory core skills are completed within the first six months of employment where this training has not previously been attended or within recommended update times for refreshers. Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 26 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): 31,33,35,36,37,38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Continuity and a structure within the management team has been established, Residents and staff feel listened to and their views may informally influence service development but quality assurance systems remain undeveloped. Systems are in place to safeguard resident’s finances managed by the home, but residents who manage their own have been placed at risk. Policies and procedures are not being updated in a timely manner to reflect changes in legislation, Health and safety checks are kept updated and the day-to-day health and welfare of residents promoted, but lack of awareness of roles and responsibilities to safeguard residents has placed them or their effects at risk. Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 27 EVIDENCE: The management of the home has now stabilised and progress has been made in developing a clear line management structure and improving staffing arrangements requiring less use of agency staff, the present manager is qualified and has many years experience in health and social care. She is still to make an application to register as manager as this has only recently been confirmed Staff report they feel more supported and find the management team approachable, the manager is enthusiastic but admits she has more to learn and has already had an impact on staff morale and consistency of care within the home with significant reductions in agency staff usage, however, the shortfalls identified at this inspection would indicate a need for the effectiveness of the present management team to be assessed over a longer period. AQAA information provided by the manager has been completed to a reasonably good standard is clear and contains relevant information, reference to how outstanding shortfalls have been addressed would have enhanced the information better. There is a need for the manager to ensure she remains updated about changes to legislation and best practice and has access to regular training to support her development and understanding of her role. Residents who have lived in the home for a number of years and have experienced the before and after effects of the management crisis generally speak very positively of the home all feel it is good and would have no hesitation in recommending it to others only one person said they thought the quality had reduced in recent years but could not be drawn into specifics The manager has told us about the ways in which residents are able to express their views about the service they receive although acknowledges no formal system for capturing and analysing this information is currently in place, and she is proposing to implement surveys shortly. Staff and residents told us that they feel listened to and were able to give us examples of where their comments or ideas had been acted upon. Some quality assurance measures are being explored e.g. medication audits, finance audits but no formal system for internal review and audit of overall service delivery is currently in place and needs to be developed. Provider visits by the nominated responsible individual are not being undertaken routinely as required by regulation 26 of the care Homes Regulation to ensure that home performance is monitored and shortfalls are addressed. The Provider is required to take action to address these shortfalls. The home has good systems in place for safeguarding residents monies and valuables, a random sample of residents monies were checked for accuracy at the site visit, three were examined and found to be accurate. Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 28 In view of the number of thefts from both staff and residents over the past year, it is unclear what steps the home has taken to raise awareness amongst residents of the importance of securing and keeping safe their effects but also in responding appropriately to the events. Some consideration must be given to improving the way in which residents who manage their own money ensure the security of their personal possessions and their bedroom generally and they should be encouraged to lock items away and to lock their bedrooms where able to. The frequency of staff supervisions has been allowed to deteriorate during the period of unsettled management, with the improved structure the manager is hoping to return to more regular 1-1 meetings for all staff. A more frequent programme of staff supervisions may have provided the opportunity for staff to whistle blow or register concerns about some of the events which have now come to light through the adult alert and it is to be hoped and recommended that the proposed frequencies are implemented and maintained and should include an element of observational supervision. Policies and procedures are updated centrally and some are in need of updating or need to be developed, this has suffered as a result of management changes at senior level over the past year. The AQAA information tells us that all health and safety checks and servicing have been undertaken, records examined indicate fire checks and tests are being undertaken regularly although the manager should ensure that night staff also participate in fire drills and this is a recommendation. Accident reporting is taken seriously and analysis of accidents sent to head office monthly. Whilst generally the day to day health safety and welfare of residents is promoted failure to ensure that staff are appointed through a robust process of recruitment and that “management” and staff have a full awareness and understanding of their responsibilities under whistle blowing and adult safeguarding guidance means that the protection of residents and their effects from harm has not been adequately safeguarded. Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 29 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 X 3 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 N/a DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 2 2 2 2 Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13 (2) Requirement Timescale for action 30/09/08 2. OP18 13(6) 16 (2) (l) 18(1) (c) 37(1)(e,f, g) All handwritten entries onto MAR sheets must be signed and dated by the person entering the information. The use of sticky labels onto MAR sheets is to be discontinued. Residents in receipt of PRN “as required” medication must have an individual guideline for each such medication to inform staff and aid consistency of administration The provider, manager and staff 30/09/08 must familiarise themselves with the adult safeguarding policy and their responsibilities under whistle blowing and adult safeguarding protocols and evidence that this has taken place. The provider must ensure that notifications are forwarded to CSCI within 24hrs of significant events occurring, where events may constitute a safeguarding issue this must be notified to the lead agency and CSCI within 24hrs or nearest time, where a Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 31 3. OP29 19 (1-6) 4. OP33 24 criminal offence may have been committed the police should also be notified. The provider must ensure that residents are safeguarded by a robust recruitment procedure that ensures that all necessary vetting and checks are undertaken prior to commencement of employment. Staff files must contain all relevant documentation. The provider must ensure that the care home is visited in accordance with regulation 26 on a monthly basis. The provider must establish an maintain a system for reviewing on a regular basis and improving the quality of care and nursing provided this must include consultation with residents, a report of outcomes of reviews including resident views must be available for inspection. 30/09/08 30/09/08 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 OP4 Good Practice Recommendations The home should take steps to ensure it can provide the appropriate facilities to support the needs of residents with visual and hearing impairments and that staff are trained to support residents with these needs. That staff that make entries onto residents daily care records, record the date, time and their job designation on each entry made, in accordance with the NMC guidance on Documentation and Record Keeping. (This is outstanding from the previous inspection). 2. OP7 Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 32 3. 4. OP8 OP8 The home should now progress and implement the use of a pain management tool in care plans, when appropriate. A review of existing resident risk assessments should be undertaken to ensure these have been individually developed take full account of the specific needs of the resident concerned and are not an add on to a general assessment, this must be kept under review. The home should make clear within complaints information what outcome has been achieved and whether the complainant is satisfied. The home should liaise with the local infection control team with regard to the lack of hand wash facilities in a first floor toilet and how this may be overcome without loss of this resource The home should ensure that care staff induction is in line with skills for care common induction standards and that this can be evidenced. The home should ensure that all care staff’ complete mandatory core training within 6months of employment. The provider ensures that the manager and staff receive regular supervision with a suitably trained person no less than six times per year; an observational element should be incorporated. The manager should ensure that night staff participate I fire drills at least twice annually. 5. 6. OP16 OP21 7. OP30 8. OP36 9. OP38 Cheneys DS0000028541.V370587.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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