Inspection on 20/11/07 for Cheriton House

This inspection was carried out on 20th November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cheriton House 13/10/08

Cheriton House 16/11/06

Cheriton House 06/02/06

Cheriton House 28/07/05

Cheriton House 04/01/05

Cheriton House 09/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Cheriton House 20 Chipstead Avenue Thornton Heath Surrey CR7 7DG Lead Inspector Michael Williams Key Unannounced Inspection 20th November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cheriton House DS0000043301.V354731.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. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheriton House Address 20 Chipstead Avenue Thornton Heath Surrey CR7 7DG 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) 020 8689 7788 020 8684 6355 London Borough of Croydon Josephine Gbadamosi Care Home 41 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (41) of places Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 16th November 2006 Brief Description of the Service: Cheriton House is a local authority care home registered to provide residential care for up to forty-one older people with varying degrees of dementia and conditions associated with old age. The home has two respite beds that are regularly used by a designated group of people. Cheriton House is a large purpose built home situated in a residential road leading off the busy Brigstock Road in Thornton Heath. It is close to local shops, transport and other amenities. The home is divided into five smaller living units and usually the same group of staff work in each unit. There are baths or showers, wash hand basins and lavatories available throughout the home. The home has the usual facilities including a large kitchen and several small kitchenettes, laundry, staffrooms and offices. There is a large enclosed garden to the rear of the property and parking spaces accessible only through security gates. Fees as at November 2007 are £540 per week. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. To monitor all aspects of this service the inspector ‘tracked’ the care provided to a sample number of residents and cross checked the information by speaking to the residents, and where possible to their visitors, and by examining the documentation supporting care; by observing the meals provided; by checking the arrangement for medication, handling money, records of complaints and accidents. Staff providing care were interviewed including carers and ancillary staff as well as managers. Questionnaires were also distributed. The Commission has also attended a number of meetings arranged by the local Social Service Department, which, in addition to routine reviews of residents’ care have investigated a number of concerns about the quality of care provided. In compiling this report the Commission has also taken account of any other information such as the monthly reports provided on behalf of the owners of Cheriton House and the AQAA [Annual Quality Assurance assessment] – which is a new self auditing tool each home is required to complete. What the service does well: What has improved since the last inspection? What they could do better: Most obviously the fabric of the building is deteriorating and must be addressed even if the home is to close within the next two or three years. The home is not ensuring new residents have had an up to date assessment by professional staff (such as a care manager). Nor are new residents being provided with a contract or agreement at the outset of their admission; Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 6 residents must be supplied with details about fees payable no later than they day they become a resident. . Care plans must be checked and confirmed as still applicable at least monthly with more detailed reviews taking place periodically. When residents are admitted as an emergency the home must make a provisional assessment of the resident’s needs and draw up a provisional care plan without delay. It is recommended that the home prepare for decision making under the new Mental Capacity Act by having suitable forms in place so individual, day to day, decisions about capacity or incapacity can be made without delay. Some residents would like their door left open and so the home must ensure it is safe to do so by installing, on any doors that are held open, electro-magnetic door-holders (which may be wired to the main fire control system or a portable version such as Dorgard). Some bed linen looked old and warn as did some of the continent sheets (‘Kylie’). Linen must be of good quality. Although most residents were well groomed a small number were wearing cardigans with buttons missing; key workers must monitor such detail to ensure residents’ dignity is not compromised by wearing clothes in need of repair. 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. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 7 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 Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 8 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): NMS 2 and 3: Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not always ensuring it gets an up to date assessment of prospective residents by the Social Service Care Manager nor are residents being provided with a contract in a timely manner. So residents cannot be assured that their needs are known to the home nor are they receiving accurate information about their admission to Cheriton. EVIDENCE: Residents were interviewed in so far as that was possible without causing them distress. There was a very pleasant atmosphere and residents looked relaxed and happy. We did not get to meet any visitors on this occasion but in the past relatives have said they are very happy with the care provided in Cheriton House. Staff and managers were also interviewed. A sample of case files was checked and care plans were seen for each resident. These care plans include general information about each resident, details of their medical and social histories as well as their wishes and preferences. Risk assessments were seen to be regularly undertaken for the case files sampled. Despite the wealth of information held in the voluminous case files there were some omissions on Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 9 this occasion. We find that not all residents are being admitted with an up to date assessment undertaken by a person trained to undertake comprehensive (single, integrated) assessments such as a Care Manager from the local authority. Assessments were given to the home but they were as much as a year old at the date of admission. Residents are not getting information about their fees no later than the day of admission - as required by the revised regulations (Regulation 5A). Typically information is not made available to residents and assessments and care plans are not put in place until after a first review of care needs some six weeks after admission. Where assessments, fees or admissions are provisional and subject to confirmation then this should be made known from the outset and should not delay the provision of information. Areas of strength include such information as the home’s staff collate at the point of admission but as two key matters require improvement, assessments and information about fees, this section, about choice, is assessed as poor. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 10 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): NMS 7, 8, 9 and 10: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan but it is not always reviewed and revised and care Plans are not being put in place at the point of admission. Health care needs appear to be met; medication practices appear sound and residents are being treated with dignity and respect so, with the proviso about care planning, residents can be assured their needs are being identified and met. EVIDENCE: The home has drawn to the Commission’s attention that Social Service Care Managers are not always providing an up to date assessment of prospective residents’ needs. In some instances this is because admissions are urgent but that is not always the case. For example, in one file we checked the resident had been receiving respite, short term care and the assessment was a year old when the resident was admitted in the summer of 2007. And the home itself is not putting in place a provisional care plan pending a review of care needs which often taken place about six weeks after admission. Care plans once in place are not being checked at monthly intervals to confirm they remain relevant to the residents’ care needs. Despite these shortcomings the delivery of care and the provision of specialist care such as Community Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 11 Nursing and contact with Doctors, seems satisfactory. The records show that specialists are called in as needed. The daily notes indicate that each resident is being supported as required, including support with washing, bathing feeding and so forth. Staff were seen to be acting a kind and gentle manner. At the time of this inspection no residents are self medicating. However, as identified before, care staff would support residents if they were able to self medicate. No errors were identified with respect to the procedures for handling medication. Areas of strength include the attention given to residents’ social and health care needs, whilst matters requiring improvement is the need for the home to require of Care Managers an up to date assessment, such as a single comprehensive assessment; a care plan to be put in place at the point of admission, even if it is only a provisional plan to evaluate care needs in the initial weeks. Care plans must reviewed monthly. So this section, about health and social care, is assessed as adequate. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 12 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): NMS 12 13 14 15: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. As far as is possible residents enjoy a lifestyle that matches their expressed wishes and preferences. The daily activities offered in the home are reasonably flexible and include a range of activities to meet the varied needs of residents. Where ever possible relatives and friends are encouraged to maintain their links with residents. Residents are offered choices wherever possible by staff. Residents are able to make choices from menus for their meals and also in their activities. Residents receive some wholesome, appealing and well balanced meals within the different units that make up the home. Dining rooms are pleasantly decorated in a homely style. EVIDENCE: The manager advises the Commission that there have been no substantive changes to the way in which these standards are being met. The Activities Officer consults with residents as far as is possible in the planning of daily activities that will meet their needs and wishes. Residents are positively encouraged to participate in these activities and at the time of the visit residents seemed to be content with life in Cheriton House. On the day of inspection there was very little evidence of recreational or any stimulating activities other than the televisions or radio on in each lounge but with residents taking very little notice of them. The small group-living units offer a Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 13 homely setting for residents, many of whom are very frail. As there is usually just one member of staff in each small unit, and sometimes only one member of staff for the two units on each floor (if one is taking a break), then there is little scope for staff to do anything other than provide for basic care needs, toileting and general ‘supervision’ of residents. Residents were frequently seen just sitting and dozing in their chairs. It is suggested that the ‘weekly activity’ list is changed; for example a calendar can be provided to list fixed and regular events such as Sunday worship; then a separate list of available activities (with no fixed days or dates) and thereafter a note on the white-boards as to what will actually be offered on the day. In contrast to the inspector’s observation on the day of his visit, when little ‘activity’ was seen to be happening, relatives in the past have spoken positively about activities available to residents and the choices that are offered in terms of food and clothes. Residents are able to make some choices in the furniture and décor of their bedrooms but bedrooms, especially those on the top floor, are looking a bit old and tired as reported in the section on environment. Relatives will be helping set an indoor Christmas Fair and this commended as an excellent way to involve groups of residents and their visitors in combined social events. Other annual events such as Birthdays, Christmas, Easter and Halloween are recognised and celebrated but regrettably there were no fireworks on November the 5th – because of ‘health and safety’ risks – it is very regrettable that regulation and the fear of litigation is reducing opportunities for some fun. Some residents are able to and do take part in community activities such as attending day centres and church groups were they have afternoon tea and cakes. Staff also take residents shopping when they are able to. On occasion staff have also taken residents to meet their partners at the family home and this is commended. On this visit no relatives were on site but previously relatives have seen enjoying time with residents. It is commendable that relatives of former residents till keep in touch wand support the home. When asked relatives said they were happy with access arrangements and communication with the home. The maintenance of relationships was discussed in some detail under the heading of diversity and meeting individual needs, whether religious, racial, social or sexual in nature. As a number of residents have surviving partners to whom they may have been married for very many years a guest room was suggested to enable private and intimate contact overnight if that is their wish. Information about any special needs or dietary requirements for residents are either made known at the initial assessment or later as needs change and plans are reviewed. Special meals are provided for residents as they require e.g. Halal meat or Vegetarian food. The midday meals appeared satisfactory, ‘home made’ sausage pie with vegetable or steamed fish. Evening meals now seemed to have improved. An evening cook was required to prepare wholesome and nutritious evening snacks and the home now has secondary cook who can prepare more wholesome and attractive evening meals. The kitchen requires a thorough clean and food stores need to be tidy and this is noted under the environment section of this report. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 14 Areas of strength are the positive attitude of staff despite the uncertain future for Cheriton House and the warm welcome given to all visitors. This section, about daily life and activities, is assessed as overall good. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 15 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): NMS 16, 17 ad 18: Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The home does have a clear, accessible procedure for making complaints and residents or their relatives do feel confident that their concerns will be dealt with effectively. Minor issues are raised informally with staff and this is acceptable to the Commission. The manager has familiarised herself with the new Mental Capacity Act to ensure residents’ rights about to their capacity, or incapacity, to make decisions and be protected is handled correctly and their rights protected. To ensure that residents are safeguarded from abuse the home has written policies and procedures to do with the protection of residents from any form of abuse. These policies come within the overarching local authority multi-agency protection policy for LB Croydon. EVIDENCE: The unit has a complaints record book in place and an Incident record. The Inspector interviewed a number of staff members who were able to demonstrate that they take any complaints raised seriously and that they know what the procedures are that need to be taken. No complaints arose during this inspection but several critical comments were made about the now very poor décor. A summary of the complaints procedure is contained in the residents’ guide, which is issued to all residents and will assist residents in making complaints appropriately. Staff have all been re-issued with the General Social Care Council’s Code of Conduct and individual staff members told the Inspector that they have read Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 16 and understood it’s contents and that each have their own copy. Staff should therefore now be aware of their responsibilities to protect residents and to report allegations and misdemeanours. Staff also have access to all the Council’s policies and procedures held within the home and including the “Whistle blowing policy” which they confirmed with the Inspector they had had a chance to read. All staff are required to attend training to do with the protection of vulnerable adults run by LB Croydon and then to attend update refresher training once every two years. This means that staff should be fully aware of the policy and procedures to protect residents from abuse, how to recognise abuse and what to do if any allegation of abuse arises. Several referrals have been made to the local authority care management team under the procedures for dealing with allegations of abuse and these have been referred appropriately indicating that not only are procedures in place but they are being adhered to. During the course of the visit the manager discussed in some detail particular issues that will affect the rights of residents and where the new Mental Capacity Act might apply. Those issues are of course confidential but one recommendation is suggested; that the home devise a suitable set of forms to demonstrate that all the necessary steps have been taken when considering a resident’s capacity or otherwise to make a decision or when decision or action needs to be taken to protect a resident ‘in their best interest’. Areas of strength include the information provided by the home to residents and the home’s positive approach towards matters of concern to residents and relatives. The manager’s understanding of and implications for residents of the Mental Capacity Act is also acknowledged. No matters requiring attention arise, so this section, about complaints, rights and protection, is assessed as good. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 17 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): NMS 19 24 and 26: Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. The décor in this home is now quite appalling and needs urgent attention if residents are to enjoy a safe, well maintained and comfortable environment. Bed linen is old and warn, so residents do not have entirely suitable private quarters. Most areas of the home clean and tidy but not the kitchen. EVIDENCE: From the outset of this visit it was apparent that decorative standards in this home have been allowed to deteriorate to the point that many areas are now unacceptably poor. Cheriton House is protected by key coded electronic gates both to the outside area and to the front entrance door of the home, and whilst it is regrettable that this level of security is required, Cheriton House is now a safe and secure environment for the residents. As entry points from the outside are all secured by key coded entry systems a requirement was made a requirement that senior management have access to the home (so that they may make unannounced checks as required by Regulation 26) by making at least one door into the home accessible from the street and this is possible. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 18 The manager advised the inspector that this was now the case and unannounced night visits by managers are being made. Within the home the general décor is no longer tidy and decorated to an acceptable standard. In many locations that include bedrooms and lounges the wallpaper is peeling off and looks most unattractive and quite degrading for residents and demoralising for staff. The home is furnished to the required standard and whilst bedrooms are all of a similar standard, layout and design they are reasonably maintained and pleasant in most areas but the décor of bedrooms on the top floor is now very poor indeed and in need of urgent attention. The home was clean in most areas and free from unpleasant odours. However the kitchen was not being maintained to a high enough standard, the corners of the floor and some areas of the walls/doors are dirty for example. Chopping boards are resting on dirty chair in the storeroom. The cold-milk dispenser is broken and parts are rusty; it must be removed; whether or not is replaced will depend upon whether it is needed by the home. An open drain was noted in the kitchen and advice must be taken as to whether or not this poses a hygiene, cross-infection or infestation hazard; it is not usual to have open drains within kitchen areas. Bedrooms have been fitted with unsuitable deadlocks (but we are told that they are not being used). It was confirmed that these door-locks, which are unsafe (as they would delay evacuation in the event of fire) are not currently needed by any residents. The Commission has again been advised that resident have not indicated a wish to lock their rooms. If they wish to do so suitable mechanisms that can be used from the inside without the use of a key must be installed (referred to as ‘hotel- standard’ locks). The open sluice, used for washing commodes is in the laundry-room and should not be located here. Areas of strength are homeliness of the small group-living units and matters requiring improvement are décor of bedrooms and improved standards in the kitchen. This section, about the environment, is assessed as only poor. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 19 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): NMS 27 to 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident to staff ratio in the home and the training and skill mix of the present staff team ensures that residents needs can be met. The home’s recruitment policy and practices include a number of detailed checks which help to protect residents. Training programmes and access to training helps ensure staff are trained and competent to do their jobs. EVIDENCE: The ratio of residents to staff means that there should be two staff working in each unit during day-time shifts and additionally one ‘floating’ member of staff who can be deployed where needed. This was the case throughout the day when the Commission inspected the home on 20th November 2007.Howver there were occasions (such as ‘handover’ or staff meal-breaks) when only one member of staff was supervising two units on each floor. The Manager of the home confirms that a careful check is kept and she feels that resident needs are being met at the moment by this level of staffing. Staff confirmed that they attend a wide range of training courses and this was evidenced by staff training portfolios on their files and noted by the Inspector. It has been again been confirmed by manager that all the required recruitment checks have been undertaken including the police checks [CRBs] and other checks that means the residents are supported and protected by the home’s recruitment policy and practices and this was confirmed by checking a sample of staff files. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 20 Whilst checking staff files the Commission noted the record of health and disciplinary issues handled by the home and the HR [Human Relations] section of the local authority. The manager is of the opinion staff absences have been addressed in a professional and lawful manner so that the staff’s rights are respected whilst ensuring the service is not compromised by poor attendance or unusual rates of sickness. The Manager has stated in previous inspections that temporary staff employed “always work dual handed with permanent staff and their work is regularly supervised and monitored by senior staff”. All agency staff are required to have minimum qualification of NVQ [National Vocational Qualification] and safety checks are made on all agency staff before they are employed. Whenever possible the home uses established agency staff who are familiar with the home and residents and this was the case when we visited in November 2007. It is commendable that nearly all staff, well in excess of the recommended 50 , have an NVQ Level 2 or higher qualification – including agency staff. The staff-room on the ground floor, which the inspector was advised was the only staff-room - there being no other rest area and no training room, is inadequate and rather poorly maintained, like some other parts of the building this room is need of improvement. Areas of strength are the commitment of the permanent staff some of whom have worked in the home for many years and the professional and helpful manner of all staff interviewed. The home is monitoring absence, sickness and other staff issues appropriately. So this section, about staffing, is assessed as good. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 21 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): NMS 31, 35, 36, 37 and 38: Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The home is managed by a competent person and is run in the best interests of residents so as to ensure, so far as is practicable, their safety and well being. Residents’ financial interests are safeguarded by the policies and procedures in operation within the home. Residents and staff are protected by good administration including record keeping and guidance issued to staff and residents. The health, safety and welfare of residents is promoted and protected by the practice and policies in place. EVIDENCE: The caring ethos, which staff feel is the home’s strongest attribute, was evidenced in the home by a number of different aspects; staff impressed the Inspector by their commitment and care of the residents. In discussions with relatives over a number of visits they confirmed that they felt their loved ones Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 22 were well cared for by staff – but they have in the past emphasised this was appreciation of the permanent and long term staff - they had less confidence in short term temporary staff. The Inspector felt that the general atmosphere in the home was positive, friendly and caring. Although it was at times a little too quiescent – during the inspection residents were sometimes seen dozing without engagement by staff, for example after lunch. Residents capable of signalling their contentment indicated that they are happy in this home so far as could be ascertained by their body language and general demeanour. Staff confirmed that they are supervised at regular intervals by a senior member of staff; the staff files confirm this. Financial procedures used for holding and spending money on behalf of residents who may wish to purchase items such as newspapers and cigarettes, have been checked on several occasions found to be. Money and accounts held in the home are also audited by the local authority – which is itself subject to independent audit of its financial probity. A number of statutory records were checked including the visitors’ book, menus, kitchen records, residents case files and staff files, accident, incident, complaints, financial audits and the fire safety records. These records are being maintained in an acceptable manner. In respect of fire safety we were told that residents would like to keep their bedroom door open; We also noted a rubber wedge inside the laundry room, it was not in use but clearly could be used to prop the door open. If there are any doors that the manager considers it would be safe to leave open then a magnetic door holder should be installed - this can be a unit wired into the main fire panel or a portable unit that responds to the fire warning system (such as ‘Dorgard’). Areas of strength include the well managed home, the positive attitude of senior/managerial staff and the positive feedback from visitors to the home. Matters requiring improvement include the need for continued refurbishment – particularly as the closure of this home may be deferred. This section, about management and administration, is assessed as good. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 23 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 1 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 3 17 3 18 3 1 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 3 3 3 Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5A(2) Requirement Fee information: the home must provide, within one day of admission, information about fees payable so residents will know what the funding arrangements are from the outset. Pre-admission assessment: The home must not admit residents with a suitably trained person assessing their needs; such assessment must be up to date at the time of admission. Care Plans: resident must be provided with a care plan without delay once admitted, this would include a provisional plan of assessment of need so that residents will know their needs are understood by care staff. Care Plans: care plans must be reviewed in accordance with good practice and no less than monthly intervals so residents will know they reflect current needs. Kitchen; the kitchen must be maintained in a clean and tidy DS0000043301.V354731.R01.S.doc Timescale for action 30/01/08 2 OP3 14(1)a 30/12/07 3 OP7 15(1) 30/12/07 4 OP7 15(2)b 28/02/08 5 OP15 16(2)j 30/12/07 Cheriton House Version 5.2 Page 25 state throughout. All surfaces in the whole of the floor, the walls, paintwork must be clean and food stores clean and tidy. Unusable equipment must be removed - and replaced if needed for catering. Outstanding from 30/12/06 6 OP19 23(2)d Décor: The home must be maintained in good decorative order until the home is closed – for the dignity of residents and to help sustain moral of staff. Linen: The home must provide suitable bed-linen, including continence aids, in good condition for all residents; this is for their comfort and dignity. 28/02/08 7 OP24 16(2)c 30/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP17 Good Practice Recommendations Rights: It is recommended that the home prepare suitable forms for recording consultations and decisions about residents’ capacity, or incapacity, to make decisions and any steps that will be taken on their behalf in their best interests. Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Cheriton House DS0000043301.V354731.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!