Inspection on 28/07/05 for Cheriton House

This inspection was carried out on 28th July 2005.

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

The inspector 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 20/11/07

Cheriton House 16/11/06

Cheriton House 06/02/06

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 Unannounced 28th July 2005 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 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 G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cheriton House Address 20 Chipstead Avenue, Thornton Heath, Surrey, CR7 7DG Telephone number Fax number Email 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 steve_liddicott@croydon.gov.uk 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 G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4/1/05 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. Ther 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 well-maintained and enclosed garden garden to the rear of the property and parking spaces accesibale only through security gates. Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home’s philosophy, described in their mission statement, is “to provide a safe, quality service, which aims to promote independence, empower people and improve their lives”. With this laudable objective in mind, the manager feels that in recent months staff moral and teamwork has improved to the benefit of service users. Whilst a large, and now quite old care home, it is divided into small group-living units and is therefore homely. However this division into groups of six to eight service users in each unit requires higher than average staff numbers to ensure they are supported and supervised at all times; this was not the case during this inspection so a revision of staffing levels and staff deployment is required. What the service does well: 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. Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Needs assessment: New service users are being admitted only on the basis of a full assessment undertaken by people trained to do so and this involves the service user or, in some cases, their representative. This ensures no service user is admitted into this home without having had their needs assessed and been assured that these will be met. EVIDENCE: A sample of case notes were checked and service users were observed but in most instances they are quite unable to reflect on the arrangements for their admission. However, staff and relatives were interviewed and they advised the inspector about the arrangements for admission. The pre-admission assessments, usually provided by a care manager in the form of a comprehensive assessment, include general information about each service user, details of their background medical and social history and details of specific issues such as mobility, nutrition, diabetes, continence, medication and so forth. Relatives agreed that the home was well prepared for the admission, staff were there to met them and to take down such details as their property list, food likes and dislikes and contact details for next of kin as well as more detailed information about their condition. Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 8 9 10 Care Plans: A service user plan of care is drawn up with each service user setting out their individual social and health care needs so staff can use this plan as the basis for the care to be delivered. Health care: The home is promoting and maintaining service users’ health by ensuring they have access to health care services to meet their assessed needs and in doing so the home is supporting service users to make decisions about how their health will be managed. Medication: The home has in place procedures for ensuring the safe management of medicines. This includes, where appropriate, support and risk management for service users who wish to be responsible for their own medication so that they may do so safely. Respect and privacy: When providing personal care staff ensure service users’ privacy and dignity is being maintained at all times so that service users feel their right to be treated with respect is upheld. EVIDENCE: Case files were checked to confirm that care needs are monitored and appropriate intervention provided either by the on-site care staff or by involving professional agencies such as the General Practitioner or District Nurses. During the course if the inspection no service users were identified as Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 9 self-medicating but care staff will support them if they were able to do so. Provision is made to ensure service users’ right to privacy is respected and several service users indicated they are treated with respect and kindness by staff. However despite these generally positive observations two points emerge; firstly, not all the case files were easy to follow so a recommendation is made to sort, index and update files. Secondly, during the interview of many of the staff and management team it became apparent that some staff may not always treat service users with professional respect and dignity. This point is dealt with under the staffing section of this report. Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 13 14 15 Lifestyle: The daily routines in this home are reasonably flexible, within the constraints of a large service, and the range of activities available, including social, religious and recreational opportunities is varied to suite the service users’ expectations, preferences and capacities. Community contact: Service users are being supported and encouraged to maintain links with family, friends and the wider community as they wish. Choice: Service users are being supported to exercise choice and control over their lives in so far as they wish and are able to do so. Meals: Service users are receiving a wholesome, appealing and well balanced diet in a congenial setting in accordance with their recorded requirements and preferences. EVIDENCE: It was not possible to discern directly from service users whether or not their lifestyle, their social, cultural and religious interests and wishes were being met but they appeared content with life in Cheriton House. The inspector met with relatives who were satisfied that the home can provide a lifestyle which meets the presumed expectations of service users. Service users are supported to keep social contacts, particularly with family and friends as seen on the day of inspection. In so far as service users are able, they are given choices and this includes choices about their clothing, daily activities and the meals provided, for example roast chicken on the day of inspection. Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 18 Complaints: The home has a clear and simple procedure for dealing with complaints so service users’ are confident their concerns will be dealt with promptly and effectively. Protection: To ensure vulnerable service users are safeguarded from abuse the home has written policies and procedures about the protection of service users and their property; this includes procedures for passing on concerns to the relevant authorities including the CSCI. EVIDENCE: A record of complaints is in place. One new complaint is outstanding and is being dealt with dealt with under the procedures for dealing with the protection of vulnerable adults. Following the manager’s own observations, and the inspector’s feedback after interviewing staff and relatives, the home intends to reconsider the arrangements for receiving complaints so as to ensure that staff feel confident that any complaints or observations they make about the care of service users will be addressed appropriately. No complaints were made by service users, or their relatives, during the course of the inspection. In contrast several compliments were paid to the home by appreciative relatives. The home has a copy of the local authority’s procedures for dealing with allegations of abuse. The management team has recently circulated to staff a copy of the GSCC [General Social Care Council] Code of Conduct and some have also been given a summary of the local procedures for reporting allegations of abuse; to the manager’s disappointment, some staff conceded that they have not read and remembered the details but they were aware of their responsibilities to protect service users and report allegations of misdemeanours. Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 26 Premises: The layout of the home and the manner in which is being maintained means that this is a safe, comfortable and suitable environment for the service users. There were however a number of matters requiring attention and they are outlined below. Hygiene: The premises are being kept clean, hygienic and free from offensive odours and systems are in pace to control the spread of infection. EVIDENCE: Communal areas are pleasantly decorated and individual rooms, though not spacious, have the required range of suitable bedroom furniture and fittings (though no ensuite facilities). Minor damage noted in some areas such as damage to walls and some walls were grubby. The layout of the premises, into group living units, and the tasteful colour schemes make this a large but homely environment. The home was clean, tidy and free of unpleasant odour. Bedroom doors do not have suitable locks, which would be unsafe if used, and must only be used if the room remains vacant. The home is recommended to fit suitable locks on any bedroom doors where service users indicate a wish to have their door closed and locked. Because access to this care home is now through a security gate, operated from within the building, it is advised that at Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 13 least one door is made accessible for managers to gain entry into the building in order to be able to make unannounced visits. Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 29 30 On the day of inspection staffing levels and the deployment of staff were not sufficient to ensure the well being of service users at all times. Staff recruitment includes checks required to ensure service users are protected and staff training programme is in place. EVIDENCE: There were several times when only one member of staff was deployed on the first and one on the second floor, so there were prolonged periods when one or other of the two units on each of these floors was not staffed. This meant service users were left unattended and without the necessary supervision and support. The management team has confirmed that all staff working in the home have undergone the required recruitment checks including the Police [CRB] checks as well as other checks such as health, references, qualifications, identity and permits to work where relevant. Staff confirmed that they undertake a wide range of training courses and many now have National Vocational Qualifications. The induction pack is very detailed and commendable, provision is also made for ongoing training, supervision and staff have regular meetings. Following a recent complaint, as yet unresolved, the inspector interviewed many of the staff team to assess their knowledge of the complaints procedure and the procedures for reporting suspicions of abuse. Whilst all staff had received written information (a code of practice) not all had read it and many were uncertain about the meaning of ‘whistle-blowing’ – that is, speaking out if something is perceived to be wrong. A recommendation is made to follow up the initial advice with further training and support sessions. The manager is aware that there may be lapses in the staff’ professional approach to service users and intends monitoring this closely. Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 33 38 The manager has been assessed by the CSCI as competent and is therefore registered. The manager was clear that her key objective is to run the home in such a manner as to ensure the health and well being of the service users, ‘they come first’. Records and procedures are in place to ensure the well being of service users and the proper supervision of staff. Some safety matters were noted and they are listed in the requirements table at the end of this report but this remains a safe and comfortable home. EVIDENCE: The caring ethos of this home was apparent during the inspection and the home is safe and comfortable for the service users. Whilst this is a well run establishment a number of points requiring attention were identified these are:- The person in charge, including the manager must have access to statutory records; fire exits routes must be kept clear; final exists must be available without the use of a key; cupboard in bathroom to be locked; staff must read their code of practice and be helped to understand the meaning and importance of whilst-blowing, the management will then need effective support in addressing issues of poor practice if reported. Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x x x x 1 Cheriton House G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 17 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 38 Regulation 23(4) Requirement Fire safety: Fire exits must be kept clear; final exits available without the use of a key and retaining hooks removed from doors. Timescale for action 30/9/05 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 7 Good Practice Recommendations Care Plans: It is recommended that care plan documentation be improved to make it more accessible and to ensure it contains all those matters listed in Standard 3 and in Schedule 3 in a clear, and indexed, way. Protection: It is recommended that staff be given further advice, guidance and support in understanding the GSCC [General Social Care Councils] Code of Conduct, the local authoritys procedures for protectiong vulnerable adults and the meaning and importance of the whistle-blowing policy- in particular they must be given the opportunity to read these documents. Security: It is recommended that at least one entrance to the building is made accessible to senior managers so they may enter the building unannounced as required by Regulation 26(3). G53-G53 S43301 cheriton V242125 280705 stage 4.doc Version 1.40 Page 18 2. 18 3. 19 Cheriton House Commission for Social Care Inspection CSCI 8th Floor Grosvenor House 125 High Street, Croydon CR0 9XP 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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