Inspection on 19/01/06 for Chepstow House

This inspection was carried out on 19th January 2006.

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

The inspector 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

Chepstow House 28/11/06

Chepstow House 29/07/05

Chepstow House 24/02/05

Chepstow House 15/06/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Chepstow House Old Maids Walk Ross on Wye Herefordshire HR9 5HB Lead Inspector Christina Lavelle Unannounced Inspection 19th January 2006 9:30am Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 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 Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chepstow House Address Old Maids Walk Ross on Wye Herefordshire HR9 5HB 01989 566027 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) Chepstow House (Ross) Limited Ms Sally Keene Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service Users may also have physical disabilities in addition to their learning disabilities. Service users may also have a mental health disorder that is associated with their learning disability. Service users must be at least 30 years of age. Date of last inspection 29th July 2005 Brief Description of the Service: Chepstow House provides accommodation with personal care for up to fourteen people (men and women). Service users must be at least thirty years of age and some are over sixty-five. They must need care due to learning disabilities and could also have a physical disability and/or a mental health disorder that is associated with their learning disability. Service users may use behaviour that can challenge the service and have limited communication and social skills. The home’s purpose is stated as being to offer a homely environment to the service users. Also to encourage them (through education and stimulation) to achieve as much as they can, in a way that is generally valued by society. The property comprises of a large detached house, set in a quiet location within easy walking distance of the centre of the market town of Ross-on-Wye. The property was originally an old house with two floors, which has been extended. All the bedrooms are single and there are five on the ground floor and six on the first floor in the main part of the home. There is a separate four bedroom flat on the ground floor. Two bedrooms have an en-suite toilet and shower. There are two sitting rooms for service users (the one is in the flat and includes a dining area) as well as a separate dining room in the main part of the home. The garden is situated at the front of the house and has a patio area and a ramp for access. There is also a small-enclosed courtyard area that can only be reached from the house and is the designated smoking area. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out in less than three hours during the morning on a Thursday in winter. The main aim was to obtain an impression of life at the home as experienced by service users. Also to check that the home still offers a good quality service and is meeting it’s stated purpose. For more detailed information about the care, service and facilities provided by the home you should also read the report made following the previous fuller inspection, which was undertaken on the 29th of July 2005. Most service users were at home today and time was spent in their company. A music and movement session was taken by an outside facilitator, which a number of service users took part in and the inspector sat it on. Others were escorted out for walks or into own shopping with staff. Staff on duty discussed the service users’ and their care, their own training and experience of working at Chepstow House. The manager was available later on during the inspection as the home’s Consultant Psychiatrist was also visiting the home today. They were all very open and helpful with the inspection process. Some parts of the premises were seen and various records relating to service users’ care, staffing and safety in the home were looked at. All the written correspondence and any other contact between the home and the Commission since the last inspection were also taken into consideration. This includes copies of reports made by the provider about how the home is running; service audits and notifications of events in the home that had affected service users. What the service does well: Chepstow House is in a very convenient place for getting to the shops, cafes etc. in Ross-on-Wye and most service users can walk into town. The home also has two vehicles to provide transport for outings further afield. The house is very comfortable and is well decorated, furnished, equipped and maintained. Service users have personalised their bedrooms and they looked very nice. There is a friendly and welcoming atmosphere in the home. Staff were caring towards service users and spent time talking with and encouraging them to join in an activity session. Service users and staff clearly get on well together. Although some service users are older and were getting frailer, staff had the time to help them all to go out as much as possible. They had supported them to join in activities and/or day services for people with learning disabilities. The more able service users are involved in schemes such as recycling and one person was doing a life skills course at college. Staff also helped them to mix with other people and to become more part of the local community. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 6 Good care planning helps to make sure staff know service users’ needs, goals and wishes and how to meet them better. Keyworkers also make the care and support given to each service users more personal. Staff had received training so they know about service users’ needs and how to meet them and do their jobs properly. This includes training for new staff, which is especially for staff who support people with learning disabilities and by them achieving an NVQ qualification in care. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&5 Suitable information is available to help prospective service users decide if they might like to live at Chepstow House and if the home could meet their needs. EVIDENCE: Most of these Standards were not fully assessed, as there had not been any new service users admitted to the home since the last inspection. However it was previously confirmed that appropriate information documents are provided about the home including a statement of purpose, a service users’ guide and a terms & conditions of residence (contract). It is good that the home had now produced the service user’ guide in a format which includes a photograph of the home, symbols and pictures. This should make it easier for prospective service users (who have learning disabilities) to understand it. There was a vacancy at the home currently. The manager described how the assessment process for a prospective resident had appropriately involved their family and an external advocate visiting Chepstow House to look around to check if the home could meet this person’s needs. The manager also planned to visit them at their current residence to assess their needs before a decision would be made about them having a trial stay and/or living at the home. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 8 A thorough “person centred” care planning system helps to make sure that staff know all service users’ needs and wishes and how to meet them better. Service users are also supported to make choices and are involved in making decisions in their lives and about the home. EVIDENCE: Some of these Standards were not fully assessed. However samples of care records seen during the last inspection confirmed each service user has a care plan and relevant risk assessments had been carried out. This is necessary to ensure care staff know all service users’ needs, goals and wishes and how to meet them. Whilst also keeping them safe and promoting their independence. One person’s care records were looked at and showed an appropriate “person centred” approach is taken to care planning. This means that service users are consulted about their goals and preferences, which are reflected in their plans. The extent of their involvement is dependant on how well they can express their views and those able to had signed their plans. Keyworkers are allocated to service users from the staff team and they give more individual support and review their plans monthly. The manager confirmed six monthly care reviews are made with a formal review held annually, involving relevant other people. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 10 It was apparent service users are encouraged to make choices in their daily lives and routines. Service users meetings were also held monthly when they were involved in making decisions about the day-to-day running of the home. The manager was currently trying to engage local advocacy services to facilitate these meetings and to support individual service users (in particular those who do not have families who maintain regular contact with them). Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 14 Staff support service users to take part in a range of activities (some within the local community) to help them lead fuller and more interesting lives. EVIDENCE: Each service user has an activities plan, which appropriately takes into account their social needs and interests and includes their short and long term goals. Only one service user was out at a day service today as some are quite frail and others have difficulty being involved in community activities, due to their behaviour. However staff said most service users went to local day services on a varying number of weekdays; others now take part in a farm project and one service user was on a college course to help them develop their life skills. Service users often go for walks and into town with staff and the home has two vehicles to provide transport for outings. They are involved in Ross “Leisure Link” social activities and attend local events. A weekly music & movement session was held in the home today. Many service users took part and really seemed to enjoy it and talking with the facilitator. Staff were very encouraging and clearly view this and social interaction as an important part of their role. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Suitable arrangements were in place to meet the health needs of service users. EVIDENCE: It was confirmed that records are kept of service users’ health and any issues identified are closely monitored and dealt with. Attention is also paid to their psychological and emotional needs and to managing challenging behaviour. It was good that staff had been proactive in helping one service user with a particular physical condition. Also the needs of older people in the home had been considered as they developed age-related physical problems in addition to their learning disability. This includes dementia and the manager had attended a session on dementia related to people with Down’s syndrome. The home also had policies and procedures for personal care and care of the dying. The manager discussed the input received from local health care professionals, such as a Psychologist, Speech therapist and OT. The home also employs the services of a Consultant Psychiatrist. He was making his monthly visit today and had seen some individuals and given the home advice about other matters Service users are supported to attend routine health related checks, such as the Dentist, Optician and each has an annual well woman and man check. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These Standards were not fully assessed. However the home or the Commission had not had any complaints or concerns that could affect vulnerable adults raised with them since the last inspection. It was previously confirmed the home provides a complaints procedure that is in a suitable format for service users. Also that Adult Protection policies and procedures (including whistle blowing) are provided for the staff team and they had received relevant instruction relating to them. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Chepstow House is suitable for its purpose and meets service users’ needs. The home provides a clean, safe and comfortable environment and there are appropriate arrangements in place to ensure the accommodation is kept clean and is well maintained and continually improved. EVIDENCE: Chepstow House is in a convenient location near Ross-on-Wye town and the building fits in unobtrusively with the local community. The general impression of the accommodation is very comfortable and the house was warm and tidy. Decorating and improvements to the property are ongoing. Some corridors and a few bedrooms had been painted and re-carpeted recently. The sitting room in the flat had a new sofa and carpet and it was planned to upgrade the home’s heating system soon. It was seen that most of the chairs and sofas in the large sitting room were low and as some service users have mobility problems it was difficult for them to get up and down, even with staff support. Staff said this had been recognised and there were plans to purchase more suitable furniture soon. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 15 The home was clean and tidy and there is a cleaning rota for staff to ensure all the household tasks are completed. It was good staff were to enrol on an NVQ course related to domestic work to help them with this part of their duties There are policies and procedures relating to good hygiene and infection control. Some staff had completed a comprehensive distance-learning course on infection control through a local college. The home provides disposable gloves and aprons for staff use and yellow bags and contracted hygiene containers for the disposal of clinical waste. Suitable hand washing facilities are provided, with anti-bacterial liquid soap and paper towels as is expected. This all reflects due attention is paid to good hygiene and infection control. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 35 Suitable staffing levels were being maintained by an appropriately trained staff team. There will be greater stability in the home (which also promotes consistent care for service users) when less agency staff need to work there. EVIDENCE: There were four staff (two seniors) and the manager on duty today, which has previously been accepted as the minimum level necessary to meet service users’ needs. The manager confirmed this staffing level was being maintained. There were two staff vacancies, although one person had been appointed and was just awaiting their CRB check before starting. The manager said the home was now advertising across a wider area to attract more applicants. However, unfortunately there were also three staff sick and two on maternity leave. Agency staff were consequently being deployed on a daily basis to cover the home. Whilst this is unavoidable in the circumstances agency staff are unlikely to know the service users so well and to have the same level of commitment to the home. It will be better for service users and consistency of care when the staffing situation becomes more stable. All contracted staff had either achieved or were doing NVQ training. Most had completed and four staff were doing LDAF induction/foundation training which is accredited especially for staff who care for people with learning disabilities. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These Standards were not fully assessed. However the management arrangements for the home have not changed. The manager is suitably qualified and experienced and continues to do training to increase her skills and knowledge. For instance she recently attended a course on employment law, including disciplinary and grievance processes and equal opportunities. The home appropriately operates a formal Quality Assurance system, which includes a comprehensive audit and monthly visits from the provider to check and report on the conduct of the home. Service users are also asked for their views of the service in meetings and through user-friendly comment sheets. The registered persons had ensured the Commission was notified about any events in the home that had or could affect service users. This shows the home has an open approach and had taken appropriate action to deal with the incidents that included accidents, a death and some staff disciplinary matters. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 18 There were no health and safety hazards noted on this day. The fire log was checked and all the required tests and checks on the fire safety system and equipment were recorded as having been carried out at the specified intervals. Fire drills had also been arranged as they must be. Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 X 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X X X X X X X X X Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NA 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chepstow House DS0000041406.V278588.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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