CARE HOME ADULTS 18-65
Chescombe Lodge Westbury Park Bristol BS6 7JE Lead Inspector
Karen Walker Unannounced 23 & 26th May 2005 08.45 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Chescombe Lodge Address Westbury Park Bristol BS6 7JE 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) 0117 9735197 0117 9706903 The Chescombe Trust Mr Kevin Johnson PC Care Home 16 Category(ies) of LD Learning disability (16) registration, with number of places Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: May accommodate up to 16 persons aged 18 - 65 years. Date of last inspection 15 February 2005 Brief Description of the Service: Chescombe Lodge is operated by Chescombe Trust and is registered to provide accommodation and personal care for up to 16 persons, aged 18-65 years, in the learning disability category. The home accommodates people with a variety of complex needs, some of whom display challenging behaviour. The aim is to provide a comfortable and homely environment in which individuals can be supported to participate in community living.The home itself is a large building that requires high maintenance and is not entirely suited to its purpose. It has spacious grounds and blends in well with the local area. It is close to local facilities and amenities, including public transport, the Downs and is adjacent to Westbury Park. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out over a two-day period. The inspector met with residents’ and their key-workers and examined individual care plans. The management team were available to offer support and information. Records relating to health and safety were also examined. What the service does well: What has improved since the last inspection?
Steps to improve the recording and documentation systems in the home provide clearer evidence to the way care is delivered. Staff are commended for their efforts.
Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 6 Residents’ benefit from consistent care from staff now that the management team offers support to residents’ whilst staff attend handover. Care plans are now well recorded and a senior member of the management team has delegated responsibility for health care, ensuring that residents’ health care needs are monitored. Staff said that Regular one to one supervision now takes place. Senior staff have chaired staff meetings and these have been helpful in providing an opportunity for senior managers to talk about their specific areas of responsibility. The acting manager and the assistant manager both confirmed they had achieved their national vocational qualification 4 in management. Records show that another senior manager has also achieved national vocational qualification 4. What they could do better:
Whilst there was much valuable information in place to support residents’ there was a lack of appropriate risk assessments. Risk assessments are needed to ensure all activities that residents participate in are so far as reasonably practicable free from avoidable risk. This includes the ‘locking in’ of residents in their bedrooms at night and highlighted mobility issues. Although doors are locked at night it was made known that all residents can open their doors at will and no one is restricted in any way. The risk assessment will clarify the benefit of this procedure. One particular resident is ‘restrained’ on a regular basis due to aggressive outbursts and physical attacks on both residents’ and staff. The home is required to seek a placement review to determine how the needs of all residents, can be best met. The home must act to protect residents from physical harm resulting from the issues referred to above. It is also required that the home send a breakdown/review of challenging incidents to the CSCI on a monthly basis highlighting the type of incident, if restraint was used and to what degree and/or if PRN medication was used. This will also serve as an ‘at a glance’ review for the home and may help to pinpoint contributory factors. It is recommended that the management team contact the Bristol Intensive Response Team (BIRT) for support with challenging behaviour issues. Records show that key-worker reviews should take place on a monthly basis this is often ad-hoc and it was explained that there was not a lot of time for record keeping due to the demands of the residents’. One residents file did not contain a contract stating the terms and conditions of occupancy. This is needed to satisfy legislation.
Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 7 The environment does not lend itself to its stated purpose and the inspector was told that the manager has been tasked by the Trustees to find alternative accommodation either in smaller units or a plot of land. Staff members say ‘they are always saying that’. The manager however is keen to point out that this type of relocation cannot happen overnight and due care and consideration must be given to finding the ‘appropriate’ placement. Staff say they feel ‘stressed’ at times due to working with a particularly challenging resident and the incompatibility of the resident group. Residents’ are at risk of not being supported adequately in the event of a fire. The fire officer will be visiting the home in June 2005 and the appropriate requirements have been made throughout this report to reduce the risk. Some staff members confirmed they have not received first aid training since 2000. The Care Standards Act 2000 states ‘the registered person shall make suitable arrangements for the training of staff in first aid’. The manager is advised to contact the HSE with regards the frequency of training and the number of staff with a first aid certificate required to be on each shift. The kitchen was found to be dirty and requirements have been made to ensure deep cleaning including all cupboards inside and out, fridges inside and out, freezers defrosted and cleaned. The door of the storage room must be replaced and the room cleaned. Cooked food and ‘leftovers’ must be clearly labeled and dated. This was highlighted at the last inspection in February and a requirement made. The inspector will monitor the progres of requiremtns and action will be taken accordingly. 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. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 9 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 standard(s) 2,3,5 Not all of the residents’ needs are being met. There are restrictions on choice and freedom in order to protect residents from physical harm inflicted on each other. Not all residents’ have contracts and therefore promised services and terms and conditions of occupancy are not made clear. EVIDENCE: The inspector saw that whilst some residents had detailed contracts one resident did not have a contract in place outlining the terms and conditions of occupancy. This is particularly relevant to this resident who requires 24 hour support on a one to one sometimes two to one basis. There remains an acknowledgement that some residents’ are not compatible, even though many have lived together for a long time. It is apparent from the inspectors’ observations and feedback from staff that some residents’ are having an adverse effect on each other, leading to incidents of behaviours that may challenge. There are recorded incidents of aggression towards staff and residents’ on an almost daily basis. The staff team are working hard to provide the quality of life residents’ can enjoy but it was explained to the inspector that this is often dictated by one particular resident. The Trust have recognised these difficulties and have tasked the manager to find alternative properties or land to accommodate smaller resident groups of compatibility. However staff confirm that this has been a long process and
Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 10 therefore a requirement is made to reassess the placement and the needs of one particular resident. There are currently 3 vacancies at the home and the management team confirmed no admissions would be made due to the relocation plans. This is good practice. The inspector at the last inspection noted that a statement of purpose was in place; this was not examined at this inspection. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 11 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 standard(s) 6,7,9,10 Able residents are aware of their assessed needs and have input into their care plans. Whilst some residents’ are supported to take risks as part of an independent lifestyle this is not done within a structured risk assessed framework which could put residents’ at risk whilst in the home and in the community. EVIDENCE: 3 care planning folders were examined in full whilst a number of others were used to extract specific information. The information contained in the care planning folders seen was detailed giving a full picture of the individual’s strengths and needs. One staff member said she carried out the care plan reviews with her key-person present and always shared information with them. The inspector was pleased to see ‘positive reputations’ were in place alongside rituals and routines. One folder contained clear detailed information on managing behaviours that are seen as challenging. However the inspector felt the statement ‘taken with care away from the situation’ needed to be further explained so as to record the ‘limits’ in restraint and moving a person. This was discussed with the acting manager who said that if staff were not trained in restraint techniques they would not be allowed to use it and would always be
Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 12 working with a suitably trained person. Further documentation shows restrictive physical interventions including, the behaviour displayed, the initial reactions and trigger words to avoid. The inspector saw one detailed risk assessment regarding behaviours that challenge there were no other risk assessments in place. It was noted that residents are ‘locked in’ their bedrooms at night for safety. Although the acting manager said all residents knew how to open the door from the inside it is a requirement to ensure a detailed risk assessment is in place recording in each case the details why the door needs to be locked and what is the risk if the door is not locked, also if it is with agreement from the individual. It was also noted that one resident has increased ‘wobbly moments’ needing staff to ‘physically support’ him to walk at times. It was noted that he is particularly unsafe on the stairs at these times and has been stopped accessing his bedroom for a limited period. This must be detailed in a risk assessment. One staff member spoke about the confidentiality policy and gave examples of where it may be necessary to breach a confidence. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 13 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 standard(s) 11,12,13,14,16,17 As far as possible residents’ are encouraged and supported to become a part of their local and wider community ensuring inclusion and opportunities for personal development. Residents’ goals and aspirations are recognised and support given to fulfil them. One person is not afforded the same opportunities as the other residents’ due to his complex needs and there is a possibility of isolation no matter how hard staff try to integrate him. EVIDENCE: The assistant manager explained how one resident who displays behaviours that challenge is supported in the home. Activities are usually planned on a daily basis depending on the level of support needed by the resident. Usual activities include ping-pong, walking around the garden and a train set. The ‘snoozlum room’ designed to provide sensory stimulation has been dismantled in a plan to move the room upstairs and the resident’s room downstairs to better manage his increasingly poor mobility. Staff members spoken with
Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 14 thought this person was not receiving the appropriate stimulation and loud noises including residents’ who are loud increases the likelihood of a display of behaviours, which may challenge. At the last inspection it was noted that the management team have taken a number of steps to improve the home’s approach to leisure time activities. The inspector considered that staff should be commended for their efforts, whilst recognising that the difficulty with the building and incompatibility of some residents’ meant that it is difficult to fully provide the lifestyle for residents’, which staff aim for. A requirement has been identified in this report to ensure a reassessment of placement and individual needs is carried out by the relevant social services. The acting manager said the home has been in touch with the relevant social services however there was no social worker allocated. The inspector spoke with one key-worker who said her key-person has a variety of interests and enjoys trips, bowling, cinema and meals out. He attends Lawrence Weston College and enjoys going ‘out and about’ with them. The inspector met with one staff member who was planning a trip out to the airport with his key person. Risk management was discussed and the staff member was knowledgeable of this resident’s needs and behaviours that challenge. A risk assessment was completed before the activity took place. There is a plan to increase this resident’s opportunities and a plan is in place to take the resident up in a small aircraft with one to one support. The trip has been well thought out and a risk assessment is being formulated. A 5-point harness is available and thought has been given as to which seat the resident should sit in for safety reasons. A radio has been purchased to enable the resident to listen to the pilots talk to the tower; an activity, which the inspector is told, gives him great pleasure. At the last inspection the inspector met with the senior social care worker who has responsibility for the coordination of leisure activities. There is particular emphasis on activity and encouragement of personal development through peer, age and cultural activities. This was seen to be good practice. The inspector found the member of staff to be enthusiastic about his responsibility and spoke of a number of activities underway. Records relating to day services evidenced that residents’ are supported to access local community facilities. Staff endeavour to ensure that residents’ can are involved in the local community and with the running of the home. The home has a number of vehicles through which this is achieved. Staff reported that due to an incompatibility between some residents’, some are not able to go out as much as they may wish. This is due to potential health and safety implications and also the need to ensure that residents’ going out can enjoy their activity without fear of challenging incidents. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 15 The inspector spoke with the cook and examined the weekly menus. Menus were varied and took into account likes and dislikes and dietary requirements. There was fresh fruit and vegetables available and the cook was observed preparing a large fresh salad to accompany the quiche. There was also an alternative choice available of liver, bacon and mashed potatoes. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 16 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 standard(s) 18,19,20 Residents healthcare needs are addressed and multi-disciplinary solutions sought to arising difficulties. Residents receive support with personal care in a way they prefer and with dignity and respect for the individual. EVIDENCE: Care plans show clear detail about residents’ personal care needs and preferred routines. One senior manager of the home holds specific responsibility for health care and bearing in mind the specialist nature of the home and high level of need service users have, this is a good delegation of responsibility to support the registered manager. It was noted through case tracking that one resident who has increased ‘wobbly’ episodes is currently receiving support from the Psychiatrist. Medication is reviewed, however some staff feel that the medication levels are at present ‘too high’ and as a result the resident can become increasingly unsteady on his feet. This is being constantly reviewed. The acting manager confirmed that medication was an issue if it was not at the right level unacceptable behaviour would increase and if too high there would be unwanted side effects i.e. ‘wobbly’ sleepy etc. Much has been done to alleviate these problems.
Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 17 There is an appointment made to review this person’s epilepsy at the Burden Institute. The inspector was pleased to note that an occupational therapy and physiotherapy referral had been made. The inspector recommends that contact be made through CLDT with the Bristol Intensive Response Team (BIRT) for up to date advice on all aspects of supporting a person with behaviours that may challenge. Records show that the appropriate healthcare facilities are accessed and the appropriate treatment given. The inspector observed the 11.00am medication being dispensed on day two of this inspection. The NOMAD system is used where staff dispense medication from a pre-filled box clearly labelled by the pharmacist. ‘As and when’ (PRN) medications x 3 were chosen at random and balances checked by the inspector. All were found to be correct at the time of the inspection. The inspector noted that medication prescribed in December 2004 (Temazepam) was correctly stored but had not been signed in or a record kept of administration. The acting manager was able to explain to the inspector why the medication had been described as a short 3-day course and said she would see that the 2 unused tablets were returned to the pharmacy today, she would also look into the reasons for the lack of recording. One resident receives monthly medication reviews due to ongoing problems. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 18 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 standard(s) 22,23 Whilst every effort is taken to ensure residents are protected from abuse and physical assault this is not always the case. Residents are at risk from being hit, scratched, punched etc by fellow residents’. Staff advocate on behalf of residents’ and complaints are acted upon. EVIDENCE: Due to a significant level of recorded incidents of behaviours that challenge, it was agreed, at a previous inspection, that an internal form could be used to record incidents which would filter out the inappropriate reports being sent to the CSCI. The inspector viewed these forms and noted a high incidence of behaviours that challenge. The inspector reminds the registered manager of the duty to ensure all requirements under Regulation 37 are being complied with. One member of staff told the inspector that ‘perhaps the CSCI should be aware of more incidents and that 6 to 10 internal forms were being completed a week’. The inspector is happy with the agreed system but requires a break down of all incidents indicating the type of incident and whether restraint and/or PRN medication was used. This can be forwarded to the CSCI with the regulation 26 reports for ease. This system should provide a way for the home to adequately review care and look for ways of improving. The registered manager has addressed the identified training need concerning the management of challenging behaviour. Positive feedback about the training was received although one staff member said she would like regular refreshers. However it was noted that the Trust is establishing an ongoing relationship with the appropriate training provider to review and refresh their training on a regular basis. At the last inspection the inspector was given a copy of the training programme. Challenging behaviour however remains of concern and
Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 19 requirements have been made throughout this report in an effort to address this. The registered manager ensures he is included in regular POVA meetings with the local Social Services lead officer. This professional contact will enable him to share his valuable experience and gain from the joint agencies involved for the benefit of the home. Staff members spoken with were aware of the ‘abuse’ policy and of the ‘whistle blowing’ policy. Staff members were clear of their accountability and responsibility and said they would always advocate on behalf of residents and make their concerns known. It was noted that Protection of Vulnerable Adults training took place in-house and the inspector was told it linked with the ‘No Secrets’ in Bristol DOH guidance. The inspector recommends that staff attend ‘Protection training’ delivered by Social Services. This is a free service and is provided by the adult protection specialists. There are also other training opportunities offered. Whilst the inspector feels that steps are being taken to ensure the health and safety of residents’ and the home attempts to support each person on an individual basis it is evident that the difficulties of resident incompatibility remain and incidents continue. The complaints log was seen and two complaints were noted since the last inspection. Complaints were recorded on loose-leaf entries and the inspector recommends that a book be used to record complaints or pages numbered thus reducing the possibility of missing pages. It is further recommended that the complaints be recorded by way of date, complaint details, action to be taken by whom, outcome, follow up and signature. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 20 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 standard(s) 24,25,26,27,28,30 Residents’ do not benefit from a clean well-organised kitchen. The home is not suited to its stated purpose. EVIDENCE: Not all standards were fully assessed at this inspection but were assessed in February 2005. Two requirements were made in February regarding the decoration of the dining area and the replacement of a rusty radiator. The dining area redecoration was also required in November 2004. An extension for the completion of this requirement has been agreed with the last inspector as 29/07/05. The inspector at this inspection was assured by the acting manager that quotes had been received and agreed and works would take place. This will be followed up at the next inspection/visit. A further requirement was made concerning the ‘fire door’ and appropriate fire risk assessment. It was evidenced to the inspector that the fire officer was booked to carry out a fire inspection on 8/06/05 and would look at the installation of fire doors etc. Requirements have been made at this inspection in respect of fire training and system checks.
Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 21 Chescombe Lodge is set back from the main road and blends in well with the local community. It has large grounds, which are used by residents’. There are some areas requiring attention for e.g. the fishpond. The premises are a listed building, which is not entirely suited for its stated purpose. It requires high maintenance and is subject to significant wear and tear instigated by residents’, some of whose challenging behaviour results in damage to décor. Chescombe Trust has been looking for alternative premises for some time and there is recognition that the building is not entirely appropriate for its use. The manager Mr. Johnson told the inspector of the long term plans for Chescombe and the hope that they would have secured a plot of land in an appropriate location shortly. He added that all residents’, relatives, care managers and appropriate others would be consulted and needs assessed. The inspector toured some of the environment and noted that two bedrooms seen were individualised and suitably decorated. There are plans to move one bedroom to the ground floor to support a residents mobility needs. Much work needs to be done to the room to ensure it meets with environmental requirements i.e. a washbasin to be installed. The acting manager confirmed this was underway. The TV room was bright and tidy and the music room housed the play station and the digi-box. Staff endeavour to keep on top of any unpleasant odours and are constantly cleaning the carpet. The games room is in need of redecoration and the carpet is badly stained. Whilst it is understood that it would not be practical to spend large amounts of money on the environment due to the plans to move the manager should ensure all living spaces are reasonably decorated. The inspector met with the cook who only commenced employment yesterday. However she had worked for the Trust in the past and was aware of the residents’ needs regarding nutrition. A tour of the kitchen was undertaken. The inspector found cupboards that were dirty and stained with food and finger marks. Fridges were dirty and in need of deep cleaning, freezers were in need of defrosting and contained unlabeled and undated food and lids had fallen off of containers. The door had fallen off the kitchen storage area. The findings were discussed with the acting manager and a requirement made. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 22 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 Residents’ benefit from a competent and experienced staff group who regularly receive the supervision and support needed to ensure needs as far as possible are met. EVIDENCE: The Trust, registered manager, training manager and staff team have shown full commitment to training. The pre inspection questionnaire received in February prior to inspection shows a clear record of training, past, present and ongoing. It is clear staff are well supported with their training needs and the home has the benefit of an NVQ assessor. The training programme holds a high priority and staff are fortunate in having this level of organised support. The training manager has an array of certificates displayed and it is evident that knowledge is shared and passed on. There are eight staff on duty throughout the day for thirteen residents’ and this reduces to six in the evening. Two of these staff are allocated as one to one support. There are two ‘waking night staff’. Although the management team feel this is adequate to support the needs of the residents’ there was one incident where a staff member felt she was working with inexperienced bank staff and a staff member did not show up for duty. This was recognised by the acting manager who gave the staff member the opportunity to talk to the
Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 23 inspector and said she would discuss this incident with her. The acting manager said it was policy to ensure only experienced staff offered one to one support and were available on each shift, unfortunately a staff member failed to turn up for duty with no prior warning thus making the staff member on duty feel vulnerable. It was noted at the last inspection that the staff turn over was low and that the investment in staff training has been a contributory factor. Staff members confirmed they had a job description and contract of employment. One new staff member spoke of her commitment to the service and was pleased to have begun a robust induction. She said it was planned for her to ‘shadow’ a staff member and would be joining in a residents’ activity this afternoon. She added that she did not commence employment until her CRB had been returned. The inspector took the opportunity to examine 3 sets of staffing records and found all the relevant documentation was in place as per legislation. The acting manager was informed that CRB certificates only need to be kept for 6 months. It is recommended that the CRB certificates be destroyed after they have been checked by the inspector but that a record of the disclosure number is kept for reference. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 24 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,40,41,42,43 Due to the lack of fire training/drills residents’ are at risk of not having their safety prioritized. EVIDENCE: The inspector examined the fire logbook and discussed the findings with the assistant and acting managers. Records show that fire training had not taken place for over 12 months. Given the size and structure of the building this is unacceptable. Fire drills were also ad-hoc and it was not evident that night staff were receiving 3 monthly drills or training as prescribed by the Avon Fire Brigade (AFB). There is a fire risk assessment in place however this had not been signed or dated so it was impossible to know when a review was due. The acting manager agreed. ‘Weekly’ alarm testing took place when the nominated staff member with responsibility for the fire logbook was on duty. It was recommended to the acting manager that dates be put throughout the diary for all relevant checks
Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 25 and who ever is on duty takes on this responsibility. The inspector was pleased to note that the fire officer was visiting to carry out an inspection of the premises and offer advice in June 2005. It was explained that a consultancy agency is used to support the home with policies and procedures and with generalised risk assessments. COSHH risk assessments were seen to be in place. Some Staff members confirmed they had not received first aid training since 2000 this must be addressed. There is a sound management structure within the home and staff members spoken with said they felt supported through supervision. It was positive that members of the management team now work on the ‘floor’ to allow staff to have a proper handover. The assistant and the acting manager both confirmed they had a national vocational qualification 4 in management. This is excellent and ensures a well-developed management team who can support each other as well as the rest of the staff team. Records were examined in respect of residents’ and these were found to be generally clear and well written. However there were some entries in daily records of a ‘negative nature’. This was addressed with the acting manager who said she was aware of the issue and in turn had addressed it with the staff member and was monitoring the outcome. The inspector was told that the Chescombe Trust was first set up in 1991 by parents concerned at the lack of facilities available for younger adults with a learning disability. The Trustees continue to carry out monitoring visits (regulation 26 visits) on a monthly basis as per legislation. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 26 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x 2 x 2 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 3 x 2 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 3 3 x 1 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Chescombe Lodge Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 1 3 D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 27 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 YA24 Regulation 23(2)(d) Requirement Timescale for action 29/07/05 2. YA24 23(4)(a) 3. YA3 14(2)(a)( b) 12(1)(a) That all parts of the care home are kept clean and reasonably decorated.That the dining area is decorated to an adequate standard and a rusted radiator is replaced; hallways are checked and decorated as needed; a brown stain from a high level pipe in the downstairs office is checked for any leak and cleaned; the maintenance programme should be checked to see when the next ‘deep clean’ of the kitchen is needed. The registered person shall after 8/06/05 consultation with the fire authority – take adequate precautions against the risk of fire, including the provision of suitable fire equipment.The work place risk assessment should be checked and then guidance sought from the Fire and Rescue Service and complied with. The registered person must 30/06/05 demonstrate that the residents assessment of need is kept under review. It must be reviewed and revised by the appropriate social services department where neccessary. A
Version 1.30 Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Page 28 4. YA5 5(1)c 5. YA9 13(4)(a)( b)(c) 6. YA23 13(7)(8) 24(1)(a)( 2) 7. YA42 23(40(d)( e) 8. YA30 23(2)(d) 16(2)(j) 9. YA23 13(4)(a)( b)(c) review of service provision and the appropriateness of the placement must be carried out for one person as a matter of urgency. All residents must have contracts outlining service provision and terms and conditions of occupancy. Risk assessments to be put in place relating to specific aspects of daily living where a risk has been identified. This must include: The locking of bedroom doors at night and identified mobility issues particularly on the stairs. send a monthly breakdown/review of all incidents idicating the type of incident, was restraint used and to what extent and/or was PRN medication given. Ensure all fire training/drills are carried out for ALL staff at the intervals prescribed by the Avon Fire Brigade. This must take into account training/drills must be 3 monthly for night staff. The kitchen must be deep cleaned including all cupboards inside and out, fridges inside and out, freezers defrosted and cleaned. food must be clearly labeled and dated. The door of the storage room must be replaced and the room cleaned. The home must act to protect residents from physical harm. 31/07/05 30/06/05 30/06/05 8/06/05 8/06/05 30/06/05 Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 29 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. 2. 3. 4. 5. 6. Refer to Standard YA19 YA23 YA42 YA22 YA22 YA34 Good Practice Recommendations Contact the BIRT for advice on supporting residents with behaviours that challenge. contact care direct regarding the provision of adult protection training and other approriate training relevant to the home. Add fire alarm equipment testing throughout diary to ensure it is carried out within the correct timescales. complaints to be recorded by way of date, complaint details, action to be taken by whom, outcome, follow up and signature. use a book to record complaints or number each entry. CRB certificates to be destroyed after they have been checked by the inspector but a record of the disclosure number kept for reference. Chescombe Lodge D56_26531_ChescombeLodge_225940_190505_Stage4.doc Version 1.30 Page 30 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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