Inspection on 07/06/05 for Chesham House

This inspection was carried out on 7th June 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chesham House 30/05/07

Chesham House 12/12/06

Chesham House 23/02/06

Chesham House 07/03/05

Chesham House 27/04/04

Similar services:

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

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

CARE HOME ADULTS 18-65 Chesham House 151 Newmarket Road Norwich Norfolk NR4 6SY Lead Inspector Hilary Richards Announced 7 June 2005 9.00am 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. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Chesham House Address 151 Newmarket Road Norwich Norfolk NR4 6SY 01603 452226 01603 452229 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) Mrs Penelope Baily Jane Elizabeth Olivier Care Home 6 Category(ies) of MD Mental Disorder (6) registration, with number of places Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to six (6) service users with a mental disorder may be accommodated. 2. The Home may from time to time admit persons aged 17 years. Only one 17 year old person may be accommodated at any one time. Maximum number not to exceed six. Date of last inspection 7 March 2005 Brief Description of the Service: Chesham House is a care home registered to accommodate a maximum of 6 persons in the category of mental disorder. It is linked to a specialist clinic Baskerville House, (a Private Healthcare Facility located next door to the premises), for persons who have experienced eating disorders. Once patients at the clinic are sufficiently progressed in their recovery, they are offered a period of temporary residence at Chesham House. It is anticipated that service users will be supported and enabled to complete their rehabilitation at this care home prior to attaining their independence and moving back into the community. During their stay, service users receive on going psychiatric care, therapy and support as appropriate to their needs. Additional charges made are related to the consultants’ fees in respect of mental health care services purchased on behalf of the service user. Chesham House is a large period residence located in a mainly residential area to the south of Norwich city centre. The property stands back from a main road, secluded by mature trees and walled gardens, and is approached by a driveway with some private car parking places. Service users’ accommodation is within single rooms, located on the first and second floors, with access to bathroom facilities alongside. All city amenities are easily accessible, by bus or on foot and service users can if they wish park their own vehicles in the grounds. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Announced Inspection that took place on one day and lasted for 9 hours. The Inspector interviewed the Responsible Individual, Registered Manager and two support workers. Two residents were interviewed in private and a further two residents were spoken to in passing during the course of the Inspection. A complete tour of the premises was undertaken as part of the Inspection and a number of records were also examined. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that a fully satisfactory recruitment process is followed in relation to the recruitment of all members of staff, evidence of this process must be held on staff files. The homes Statement of Purpose requires updating and a development plan needs to be put in place; staff also require training in First Aid. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 6 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. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5 The home provides clear, detailed information to residents regarding the services and facilities available within the home and the purpose of their accommodation at Chesham House. Resident’s needs are assessed prior to moving into the home and individual needs are demonstrably met on a day-today basis. EVIDENCE: The home has a comprehensive, informative Statement of Purpose in place that meets the requirements of Schedule 1 of the Care Homes Regulations 2001. The home has recently amended their conditions of registration to allow for the accommodation of 17 year olds, as a consequence the Statement of Purpose requires updating reflecting this change in registration conditions. The Service User Guide to the home provides explicit, detailed information regarding the facilities within the home and key contract conditions; previous service users views of the home are available in the communal areas in summary form. Chesham House also provide a detailed Carer’s Guide to parents/partners of residents, the standard of this guide is to be commended. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 9 New residents to Chesham House are always admitted directly from Baskerville House and are introduced to the home via a number of introductory visits, the pace of which is dictated by the resident. Residents confirmed that their wishes were given paramount importance during introductions to the home. Resident’s needs are comprehensively assessed prior to admission to Baskerville House, as evidenced by case files, and a transfer referral is completed on their admission to Chesham House. The case files that were sampled did evidence a full assessment of individual needs but this assessment was to be found across a range of reports rather than incorporated in one comprehensive document. The home is reminded that 17 year olds require Placement Plans to be completed, as detailed under Regulation 12 of the Children’s Homes Regulations 2001. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 10 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 and 10 The individual needs and choices of residents are fully reflected in their Service User plans; plans contain clear targets and goals and are regularly reviewed. All information within the home is handled appropriately and confidences are kept. EVIDENCE: The case files that were sampled contained Individual Therapeutic Plans (ITP) that detailed specific targets and goals for residents and evidenced regular updating and review. The ITP’s are completed in conjunction with residents, as confirmed during discussion with the women currently at Chesham House. Resident’s rights to make decisions regarding their welfare is fully supported although staff are sensitive to the particular vulnerability of the residents to make informed decisions regarding some elements of their care. The home has in place detailed risk management strategies regarding known and likely high risk behaviours’ the quality of these assessments is commendable. Residents are encouraged to fully participate in the community and undertake the usual range of social activities for young adults. The home has appropriate specific risk assessments and guidelines in place regarding such activities e.g. attending nightclubs. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 11 Chesham House has clear guidance to staff and residents regarding confidentiality of information. All the residents that were spoken to expressed complete confidence in the staff team regarding how personal information is handled and gave examples of how their wishes had been respected in relation to information given to their families. The staff team were observed to manage an extremely difficult disclosure by a resident in a professional and appropriate manner during the course of the Inspection. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 12 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, 15, 16 and 17 Residents are fully supported to re-establish appropriate links with the community and return to work or education where appropriate, as part of their personal development and progress in managing their illness. The daily routine of the home and structure of mealtimes promotes the independence of residents whilst also promoting their welfare and supporting the coping strategies needed for sustaining their longer term good health. EVIDENCE: The majority of residents in the home are either working and/or attending college as part of their ITP, alongside regular social contact with family and friends. The staff team provide a high level of support to enable residents to learn new and appropriate strategies for managing social situations that may involve meals, as observed during the Inspection and confirmed during discussion. All residents are encouraged to participate in a range of leisure activities. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 13 The home operates as a community and as such the provider has felt that it is not necessary for residents to have locks on their bedroom doors. The residents that were spoken to supported this decision and stated that they felt fully comfortable with the operation of the home. The daily routine of the house promotes independence and choice although elements of meal planning and eating patterns are strictly adhered to in order to promote the welfare of residents. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 14 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 and 20 Residents receive a high level of personal support from a dedicated staff team that promotes their emotional and physical welfare at all times. EVIDENCE: Residents advised that staff are always available to support them in how they manage their illness and developing appropriate coping strategies; numerous positive comments were made regarding all members of staff. The home also provides additional specific specialist support via family therapy, psychiatric support, massage etc. The health needs of the residents are closely monitored due to the specific issues relating to eating disorders. All residents in the home keep and administer their own medication, this is held in locked cabinets in their rooms. Case files evidenced a clear risk assessment for each resident regarding their medication and there are agreements in place regarding how often staff monitor stock levels. The previous requirement relating to the secure storage of medication that requires refrigeration has been addressed. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 15 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) These standards were not assessed during this Inspection. EVIDENCE: Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 16 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, 27 and 28 Chesham House offers a high standard of accommodation that is maintained, furnished and decorated in good order throughout. EVIDENCE: As part of the Inspection a complete tour of the premises was undertaken, including the garden, with the exception of 4 occupied bedrooms. The home presents as a welcoming, friendly and relaxed environment that is decorated to a high standard. The home has a number of spacious communal rooms for use by residents, alongside smaller rooms available for therapy. The kitchen is equipped with two cookers and appropriate food storage facilities; residents stated that the amenities in the kitchen were sufficient to meet their needs. Residents have single bedrooms that they are free to personalise during their stay in the home. Bathrooms are shared between residents and the sleep in member of staff; the facilities are sufficient in number to satisfactorily meet the needs of everyone in the home. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 17 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) 32, 33, 34, 35 and 36 Residents are cared for by a competent and experienced staff team who are appropriately trained, supported and supervised to meet the needs of the service users in the home. The recruitment process for the home is not completely satisfactory and a number of matters require addressing. EVIDENCE: The staff team at Chesham House hold a range of qualifications and have varying levels of experience in the field of eating disorders. The majority of staff in the home are recruited from Baskerville House and therefore have extensive experience of working with people in the acute stages of their illness. The Inspector was impressed by the level of knowledge and understanding of the staff team in relation to the specific needs of the residents in the home. All staff complete a thorough, planned programme of induction to the home followed by foundation training as evidenced by records on the premises. In addition the home provides a range of specific training for staff directly related to their field of work; the extent of this training is to be commended. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 18 The manager advised that staff in the home are undertaking NVQ 2 or 3 in Care but she feels these courses are not directly relevant to the work at Chesham House and that a number of qualifications already held by staff are more relevant. The staff team do not receive training in First Aid as required under the Care Homes Regulations 2001. The staff team and residents report that the home is adequately staffed at all times, the home does not use agency staff and has a small number of bank staff who ensure that continuity of care is provided to residents. The home hold weekly team meetings the minutes of which evidence the collective decision making within the team regarding the care of residents. Staff receive both individual and group supervision on a regular basis although the records maintained within the home lack clarity regarding how often this takes place. Individual members of staff stated that they felt fully supported by both their colleagues and managers and numerous positive comments were made regarding the overall management of the home. The three staff files that were examined as part of this Inspection did not evidence that all the requirements of Schedule 2 of the Care Homes Regulations 2001 have been met when appointing staff. It is of concern that the CRB disclosure for one member of staff relates to her previous employer and another member of staff has started work prior to her disclosure being received. The home’s administrator advised that all CRB Disclosures are returned to the YMCA for destruction after being seen by Chesham House; the administrator was advised that this practice is incorrect although the Inspector accepts this was done in good faith. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 19 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) 38 and 39 The home presents as a well-managed resource with a positive and welcoming culture and inclusive atmosphere. The home is seeking to improve the service offered to residents by implementing an effective quality assurance system. EVIDENCE: Throughout the Inspection all members of staff and residents spoke positively regarding the management of the home; comments related to both the manager and deputy manager. The observed interaction of the manager with staff and residents conveyed a clear sense of leadership within the home whilst also being open and approachable at all times. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 20 Newmarket Clinic has a comprehensive system in place to seek the views of residents and carers as they progress through the various parts of the service offered under the umbrella of the clinic. The feedback from these questionnaires has been collated and is available within the home. Chesham House has also recently had an external audit of their case records and a subsequent report noted areas of improvement. The home does not at present have a development plan based on the results of the quality assurance system. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 21 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 2 3 4 4 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 4 x 4 4 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 4 3 x 3 4 x x Standard No 11 12 13 14 15 16 17 4 4 4 4 4 3 4 Standard No 31 32 33 34 35 36 Score x 3 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Chesham House Score 4 4 3 x Standard No 37 38 39 40 41 42 43 Score x 4 2 x x x x I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 22 N/A 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 1 Regulation 4 Requirement The Registered Provider must ammend the Statement of Purpose to include the detail required by Schedule 5 of the Care Homes Regulations 2001. The Registered Provider must ensure that all staff working in the home receive appropriate training in first aid. The Registered Provider must ensure that all the requirements of Schedule 2 of the Care Homes Regulations 2001 have been met prior to staff starting work in the home. The Registered Provider must ensure that CRB Disclosures are kept for Inspection by CSCI in oredr to evidence a satisfactory recruitment process. The Registered Provider must have a development plan for the home. Timescale for action 01.09.05 2. 35 13 01.12.05 3. 34 19 Immediate Effect 4. 34 19 Immediate Effect 5. 39 24 01.11.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 23 No. 1. Refer to Standard 2 Good Practice Recommendations It is recommended that new residents needs assessments are contained in one document that meets all the detail required by Regulation 2.3 of the National Minimum Standards for Care Homes for adults (18 - 65). It is recommended that the registered provider contact TOPPS regarding the accreditation of in-house training provided by Newmarket Clinic. It is recommended that the home maintain one record of staff supervision that details when staff have been supervised, covering both group and individual supervison sessions. 2. 3. 35 36 Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF 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. Extracts may not be used or reproduced without the express permission of CSCI Chesham House I55 S28593 Chesham House V224116 070605 Stage 4.doc Version 1.30 Page 25 - 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!