Inspection on 13/04/07 for Chessington

This inspection was carried out on 13th April 2007.

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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chessington 17/10/06

Chessington 22/11/05

Chessington 19/07/05

Chessington 07/02/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Chessington Chessington 50 Marlpit Lane Seaton Devon EX12 2HN Lead Inspector Belinda Heginworth Unannounced Inspection 13th April 2007 09:00 Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chessington Address Chessington 50 Marlpit Lane Seaton Devon EX12 2HN 01297 20383 01297 20383 voyagersltd@aol.com www.voyagersltd.co.uk Voyagers Ltd Mr Jonathan Mark Higgins ** Post Vacant *** Care Home 3 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of Learning disability (3) registration, with number of places Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The care home may provide accommodation together with personal care for up to three service users with a Learning Disability, between the ages of 18 and 65 17/10/06 Date of last inspection Brief Description of the Service: Chessington care home is part of the company Voyagers Ltd. It is registered to provide support and personal care to three people who have a learning disability. The home is situated in a pleasant quiet area of Seaton but is close to the local amenities. The house has three bedrooms, one of which is on the ground floor. There is one bathroom upstairs and a separate toilet down stairs. There is a pleasant lounge adjoined to a conservatory at the front of the house and a large kitchen / dining area to the rear of the property. There is ample parking in the driveway. The home’s fees range from £1500 to £2418 per week with no additional charges. The home informs service users’ relatives and representatives when an inspection has taken place. A copy of the report is sent to all parties and the report is explained to service users. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over four hours on a weekday. The providers were present throughout. One person living at the home was able to talk with the inspector but another person has extremely limited communication skills and was therefore unable to contribute verbally to the inspection process. Time was spent making observations throughout the inspection. Prior to the inspection the provider completed a questionnaire, which provides information about the people living at the home, staffing, fees and confirms that necessary policies and procedures are in place. This information helps the commission to prepare for the inspection, send out surveys to appropriate people and helps the commission form a judgement on how well the service is run. Before the inspection took place, surveys were sent to the people living at the home. They were also sent to staff, including agency staff and comment cards were sent to professionals who are connected to the home. Four staff surveys were returned, telephone contact was also made with 3 staff, some were agency staff and some no longer worked at the home. Two comment cards from health care professionals and two surveys from the people living at the home were returned. During the inspection we “case tracked” the people living at the home. This means we spoke with them, made observations, spoke with staff and read records, starting from the admissions process through to the present. Medication practices were looked at and a tour of the peoples’ bedrooms took place. We also looked around the home and inspected other records. These included, the fire safety information, staff training records, menus, quality assurance records and recruitment files. What the service does well: The atmosphere on the day of the inspection was relaxed and cheerful. Two agency staff were working at the home for the first time. The providers were explaining to the agency staff the needs and preferred routines of the people living there. The home has recently recruited new staff and are working towards providing a stable environment. Staff files confirmed that staff are recruited appropriately and safely and that good induction training has started. On the day of the inspection no permanent staff were available to confirm how useful the induction training was or what they had learnt from it. However, the staff team are supported and guided with some good information in peoples’ files, although some further details within these records will better ensure people Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 6 are cared for in a consistent and safe way. Peoples’ health needs, on the whole, are well met, monitored and are reviewed regularly with health professionals. Health professionals who provided feedback to the Commission prior to the inspection confirmed this. The home is situated in a pleasant location close to local amenities. Service users enjoy using local facilities for shopping, cafes, seafront walks, pubs and so on. On the day of the inspection one person went to a café to meet friends another went for a walk. One person said they enjoyed being able to go out and about freely. The house is homely and decorated and furnished to a good standard. One person living there said they were happy with their bedroom and both people living there had personalised their rooms. Measures have been taken to protect peoples’ health, welfare and safety, through appropriate policies and procedures, financial practices, care plans, some risk assessments and some staff training, further work is needed to fully protect everyone. The provider has some systems in place that reviews the quality of services provided but further improvements are needed in this area. What has improved since the last inspection? What they could do better: The records of people living at the home need to be improved to ensure there is enough information to guide staff and therefore ensure people are cared for in a consistent and safe way. They need to be written in a manner that is factual and not just opinions. For example not using terms such as “good Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 7 behaviour”, describing a person as “selfish”. Where decisions are made on behalf of people, but in their best interests, records should be kept of when and who was involved in such decisions. Health monitoring needs to include dental and optical checks to ensure all health needs are met. Menus act as a guide and show a fairly well balanced diet is provided. Feedback from some staff, prior to the inspection, indicated food was not freely available to the people living at the home, food was “portioned out” and there were no fresh fruit and vegetables. One person living at the home said they had “plenty to eat” and they enjoyed the food. On the day of the inspection food cupboards were found to be empty although the provider said they were going shopping that day. The system of portioning out food did not allow people the opportunity of having seconds. The providers said the people living at the home did not enjoy fresh fruit but the providers had no sough advice from a dietician to ensure the diet was health enough. Medication practices must be improved to ensure people’s safety and welfare are protected. Suitable advice should be sought about finding methods of communicating with people with limited communication skills and enabling them to communicate with staff when they are unhappy. Advice should also be sought about suitable and healthy diets for people who do not seem to like fresh fruit and vegetables. Food in the house should be available in such quantities that provide people with choices and amounts suitable to their needs. People who live at the home must be able to live their lives without being ”shouted at”, which is unpleasant and disrespectful. The frequency of how often personal laundry is carried out should be reviewed to ensure people are not living with unpleasant odours in their bedrooms The home should continue to find training for staff that helps them to meet peoples’ needs. Systems to monitor and review the quality of services within the home should describe how, when and who will undertake the work. This will ensure all staff are aware of what needs to be done to check the home is run in the best interests of the people living there. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process provides staff with the information they require to ensure peoples’ needs can be met. EVIDENCE: There have been no new admissions since the last inspection. Further information is now available in one person’s file that was not there previously. This has helped the provider ensure staff are aware of the person’s history and needs. Care plans have been compiled using this information. The provider also said they would use their own admission forms in the future and will not rely totally on information provided from other sources as they have found this can sometimes be inaccurate. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning is good meaning staff understand peoples’ needs. However, personal records are not always appropriately written meaning that dignity, respect and choices are compromised. Decisions made on behalf of people are done so in consultation with others but record keeping in relation to this and some risk assessments is poor. This means there is no evidence showing who was involved, what was agreed and when. EVIDENCE: One person living at the home talked about the care they received. Although not fully happy with some incidents (See section 11 – 17, lifestyles), said they liked living at the home and said “I wouldn’t want to move from here, I like it”, they also said “ I enjoy being able to go out”. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 12 Care plans are produced by care managers and described the general aims of the care needed, for example, to encourage independence and to provide 24hour care. The providers have added more information to guide staff on how to respond to the people living there, for example the preferred routines and likes and dislikes. Monthly reports are written describing the progress made with each person living at the home. The reviews did not necessarily relate to the information in the care plans, but did provide good information on how people were progressing. Copies of these were sent to care managers. More detailed reviews are also held with care manager, relatives and the person being cared for. Individual daily records are kept, which described what people had done that day and what they had eaten. In some of this information staff were making judgements on behaviours without describing what they meant by it. For example many entries said “a good day today”, “in a good mood today”. The providers recognised that this could mean different things to different people therefore was not an accurate or a factual reflection on someone’s day. Another part of a care plan said “X is selfish enough to eat all of X’s food”, so had to be supervised. This was discussed with the provided who agreed it was an opinion to use the word selfish rather than being factual and could encourage staff to view and treat the person disrespectfully. Some decisions are made on behalf of the people living in the home. Some decisions are made in their best interests but may be viewed as being restrictive or invading their privacy or freedom of movement. For example, some staff told the commission, prior to the inspection, that one person’s drinks were restricted in the evening. The providers explained that due to this person’s health needs, they felt it was important they had an undisturbed nights sleep. They felt by providing too many drinks after 6.30pm, the person might have a disturbed sleep through being incontinent and might become ill the next day. This was not recorded in the care plan or discussed and agreed with other professionals to ensure the decision was in that person’s best interests. Another example recorded in a care plan stated “You can take control of the TV controls after 6pm”, (meaning staff). The providers said this person had control of the TV all day but in the evening they felt it was only fair to give others a choice of programmes to watch. The providers said this was discussed and agreed with the care manager but again had not been recorded in the care plan, with the reasons, who was involved and when. A listening device is also used in person’s bedroom because of their health needs. The providers said they have discussed this with the care manager and a member of a “Good Practice Committee”, who have agreed with its use. No record has been kept of these discussions. This would help ensure there is evidence that such decisions are discussed, when they came to an agreement and the named people involved. Assessments on areas of risk have been completed and have improved since the last inspection. Some of these assessments were good and provided staff with good guidance. However some other information did not always provide enough detail to ensure people remain safe. For example some information Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 13 described the areas of risk but did not always say what would happen if the risk was not reduced, or guide staff fully on what to do to reduce it. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are supported to make some choices about their lifestyles through using the local community, taking part in appropriate activities and maintaining relationships with families and friends. Peoples’ rights to be treated appropriately have not always been maintained, which means they have not always been treated respectfully. People benefit from balanced meals but limited food supply means there is a lack of choice. EVIDENCE: One person living at the home described outings they enjoyed, from shopping, lunches out, walks and trips into town. The person said they had many friends in the local community and enjoyed seeing them when out at cafes or during walks along the sea front. Another person has started going horse riding which the providers said they enjoyed. On the day of the inspection, one person went Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 15 out to meet friends, another went out for a walk with staff. The providers said they are also looking at different types of communication with one person, who has complex needs, by using photographs, pictures and some signs. Discussions took place about the benefit of using a speech and language therapist to ensure the appropriate method of communication is used. Prior to the inspection, some staff said that on one occasion a person living at the home had not been treated respectfully. This was confirmed by the person. The staff responsible admitted this was unacceptable and gave assurances the situation had been resolved. The commission has also spoken with the Adult Protection team and a separate letter has been sent to the home. At the moment, the provider does not complete menus for the week ahead as the home has only two people living there. The provider said, meals are discussed each day and agreements reached on what will be cooked. Records kept of foods eaten showed a varied and healthy diet is provided. However, some staff reported, prior to the inspection, that food was provided in portions in the freezer. They said the portions were small and gave no options for seconds. They also said there was little food available in cupboards or in the fridge and there was no fresh fruit or vegetables. On the day of the inspection, we found the communal cupboards had no food in them, apart from some pasta, the fridge was almost empty and the freezer was full of “portioned food”. However, the portions of food in the freezer were of an acceptable size and included portions of frozen vegetables. The providers explained that they started to portion food because staff were using a lot of food for themselves and using inappropriate amounts. They said that although they provided meals for staff, the food belonged to the people living in the home and should not be “abused”. The providers also said the reason the cupboards and fridge were empty was because they were planning to do the weekly shop that day. The providers said they stopped buying fresh vegetables because staff did not cook it and they ended up throwing it away. They said the people living in the home did not like fresh fruit. Whilst one person living in the home felt there was enough food, a dietician has not been sought out to ensure the food is healthy. Two cupboards were named for the two people living in the home. One contained a few packets of crisps, which the providers said was the preferred person’s choice of snack. The other had Easter eggs in it. One person living at the home said, “they had plenty of food and choice”. At lunchtime, agency staff were heard to offer choices to the people living at the home and one person was supported to prepare their own lunch. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples’ dignity and privacy is, on the whole, respected. People benefit from most of their needs being closely monitored but not all. Medication practices do not fully peoples’ health and welfare. EVIDENCE: One person talked about how staff supported them to maintain their independence as much as possible. They gave examples of how they were guided with their personal care and said staff were kind and caring in how they provided the guidance. Care plans described how personal care and support should be given, the agency staff demonstrated a good understanding of peoples’ needs. They were heard asking for guidance from the providers when necessary. A GP and a health professional confirmed the home communicated well with them and said they were satisfied with the care delivered to the people living at the home. However, the information provided by the home prior to the inspection indicated that some health checks were still to be arranged. For Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 17 example, dental and eye sight checks. The provider confirmed these were still to be arranged and were hoping this would be completed within the next month. One person has complex health needs, which the staff monitor and support to avoid infections. Good records are kept of those health needs, and show monitoring and reviews take place. The people living in the home are unable to manage their own medication. Consent has been obtained from one person for the home to administer and manage their medicines. Medication is supplied in liquids, boxes and bottles. It is kept in a locked cupboard in the kitchen. One person takes some medicines in liquid from, by mouth, through a syringe. The provider said during the last inspection that other liquids that could not be put in a syringe were sometimes put in drinks. The provider said this is done because, the medicine did not taste pleasant, and the person often refused it but required it to stay healthy. The person did not understand that it is in the drink but the provider has since checked with the GP that by doing this it does not change the effectiveness of the medicine. However, this agreement has not been recorded in the care plan, which is important to provide evidence of when it was discussed and agreed with a health professional. Prior to the inspection some staff said, the recording of medicines given was being carried out incorrectly. They said staff were signing the responsible individual’s initials instead of their own. On inspection of the records this was found to be the case. The provider thought this was a misunderstanding of staff and he would ensure this was put right. All staff who administer medicines have received training. The provider intends to assess staff regularly to ensure they remain competent to give out medication. A requirement was made during the last inspection relating to some medication practices were met. On the day of the inspection, the medication cupboard had a liquid medicine in an open container and a tablet was in another open container. There were no labels indicating what the medicine was and who it was for. The provider said they were administering the medicine that day and put it in the containers to save time later. This is not a safe practice. One person living at the home has emergency medicine for their health needs. This has to be taken with staff on outings away from the home. To ensure that in the case of an emergency any health professionals would know what medication that person has had that day, a duplicate copy of the medicines administration sheet is taken with them. This means when staff sign to say medicine has been given in the home, they duplicate the signature on the sheet that is taken out with them. This could be an unsafe practice, we have Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 18 sought advice from the pharmacy manager of the commission and will advice the home accordingly. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are assured they are listened to and complaints are dealt with appropriately. More appropriate complaint formats for people with limited communication needs might help them to express when they are unhappy. There are systems in place to ensure people are protected from abuse but appropriate training of staff will better protect people living at the home. EVIDENCE: The commission has received one complaint since the last inspection from a relative. This was investigated by the provider. Although the complainant was not fully satisfied, the issues are being dealt with through care management reviews involving the complainant. One person living at the home said they felt they were listened to and any worries or concerns were dealt with. The providers gave this person a pictorial complaint’s procedure but they did not like having it in their room. However, another person living at the home with limited verbal communication needs has no formal way to express if they are unhappy. The providers felt they and the staff knew the person well enough to understand when they were unhappy. However, it was highlighted earlier that there was a need to find suitable forms of communication with this person and using a speech and language therapist might help produce appropriate methods. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 20 The agency staff on duty had received training on abuse awareness and were able to describe various types of abuse and what to do should they suspect it. Information received from the provider prior to the inspection indicated that all staff, apart from very new staff, had received training on abuse awareness. However, on the day of the inspection, the provider said the training had been cancelled and new dates had to be arranged. New staff receive information as part of their induction on abuse awareness. The home has a copy of the local alertor’s guide to ensure staff have information on how to report abuse. Peoples’ finances are managed well with good records. A relative has power of attorney for person, monies are paid into a bank account for the provider to access on behalf of that person. The provider keeps receipts of all monies spent. The providers act as Trustees with a building society account for the other person living at the home. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided, on the whole, with clean, safe and comfortable surroundings that meet their needs. More frequent laundering of personal clothing could reduce the risk of unpleasant odours occurring. EVIDENCE: The home is decorated and furnished to a good standard. One person uses a ground floor bedroom to help meet their needs. Bedrooms are large, bright and airy and furnished to peoples’ taste and preferences. One person confirmed they liked their room. The home has a large lounge, conservatory, downstairs toilet, kitchen / dining room. The bathroom with shower is on the second level. The house has a homely atmosphere and people seemed relaxed in their surroundings. Prior to the inspection some staff had reported that laundry was only carried out once a week for each person living at the home. This was regardless of Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 22 whether the washing was soiled. They said one person was only “allowed” to change their clothes every three days, even if they were dirty. On the day of the inspection this person said they changed their clothes every other day but could change them more often if needed. The laundry baskets in each room were found to be overflowing with dirty clothes, one basket had a slight smell of urine. The laundry for each person was not due until the following week and the day of the inspection was a Friday, which meant that by the following week the laundry baskets would have been very full and would potentially create an unpleasant smell. The providers said washing was completed every day and in fact some was being carried out on the day of the inspection but this did not appear to be personal clothing. An agency staff said the routine guidance stated laundry was to be completed as necessary. However, this did not explain why the individual laundry baskets were so full. On the day of the inspection the rest of the home was clean and fresh. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People in the home are supported by enough caring, skilled and competent staff to meet their needs. Improvements to recruitment practices have ensured people are better protected from potential abuse. EVIDENCE: One person living at the home talked about how kind and caring staff were. They said they liked all of the staff and said they were very “helpful”. The home provides 2 carers on duty at all times. This means because one person living at the home is more independent and goes out on their own, two to one support can be provided for the other person, which is important on outings away from the home. At night the 2 carers “sleep in”. The home has recently employed some new staff to replace staff who have recently left. The provider is hoping to create a more stable team to enable more consistent care to be provided to the people living at the home. Prior to Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 24 the inspection some staff said that regular staff meetings do not take place and the providers were not easily available for support. The providers said they came to the home regularly and were also available by telephone. They confirmed that staff meetings have not taken place but hope to introduce this soon now that the team is becoming more stable. Staff records showed that new staff have received induction training and supervision where care practices are beginning to be discussed. The provider said all staff will be registered to complete NVQ level 2. The provider said and indicated in the information provided to the commission prior to the inspection, that staff have received training on, Epilepsy, First Aid, Safe Handling of Food and Safe Medicine. The provider said they hope to arrange training on Protection of Vulnerable Adults, Total Communication, Autism and manual handling in the near future. Recruitment practices have significantly improved with appropriate references and police checks (CRBs); and checks against the Protection of Vulnerable Adults list (POVA) being completed before staff start working at the home. The providers said people who live at the home form part of the interview panel. This ensures they are involved in the recruitment of new staff and gives them a choice of will be supporting and caring for them. The providers said that the person with limited verbal communication indicates clearly people they do not like or want by ignoring them. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from a home that is run adequately, but having a permanent manager will ensure the home is consistently run well. The quality assurance systems to ensure the home is run peoples’ best interests are not full implemented. Improvements to information relating to risks within the home have ensured peoples’ welfare and safety is better protected. EVIDENCE: The provider and responsible individual run and manage Chessington. However, it is a requirement that this company have a registered manager. Both the provider and responsible individual are in the process of completing Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 26 the Registered Manager’s Award, once the responsible individual has successfully completed the award she intends to apply to become the registered manager. Feedback received from one staff said the providers were supportive and “they listen to any ideas you have to improve things”. However another staff said “the providers are never around and never listen”, and when asked what they would like to change to improve the way the care home is run, said “communication between staff and management”, some of these comments were made from staff who have since left. Peoples’ records, some risk assessments and records of consultation processes as previously mentioned are not consistently recorded well. This may improve once a suitable manager is registered with the commission. The provider and responsible individual regularly review the care people receive, through care plan reviews, consulting with the people living at the home and having good contact with care managers. The home also sent surveys to care managers, district nurses and relatives, to seek their views on the services they provide. They have received positive responses from health professionals but have received no responses from relatives. No surveys were sent to the people living at the home or GPs. The provider hopes to do this in the future and hopes to find a suitable way of seeking the views of people with limited verbal communication skills views. The provider has devised a quality assurance statement that sets out the standards they want to achieve to ensure the services they provide are in the best interests of the people living at the home. However, the plan does not fully set out how they intend to carry out these standards, there are no time scales or who is responsible, which means that other staff may not be aware of when these monitors are due and what action needs to be taken. Information was provided by the home prior to the site visit indicating all necessary polices and procedures are in place and up to date. These are not inspected on the day but the information is used to help form a judgement as to whether the home has the correct policies to keep the people using the service and staff safe. In this instance policies and procedures were in place. Since the last inspection risk assessments have been put in place and others updated. The home does not have a fire alarm system, the fire department advised the home to install smoke detectors, two of which were connected to the home’s electrics and five are battery operated. A fire blanket and a fire extinguisher is installed in the kitchen. The provider checks the smoke detectors each week and keeps a record of the checks. This ensures peoples’ welfare and safety is protected. The provider has recently completed risk assessments relating to reducing the risk of fire. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 X 3 X X 3 X Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 28 No 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 YA16 Regulation 12 (4) (a) Requirement Timescale for action 15/05/07 2. YA20 13 (2) 3 YA37 8 The home must be run in such a way that people living there are treated in a manner which respects their dignity. The registered must ensure that 15/05/07 medicines are dispensed and signed for correctly to ensure people receive the correct medication and those responsible for administrating it sign to say they have given it. The company must employ a 30/09/07 manager and submit an application to register that person with the commission. 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. Refer to Standard YA6 YA7 Good Practice Recommendations Care plans should be written in a manner that is respectful and factual. Any discussions and agreements reached with other professionals about decisions made on behalf of service DS0000061472.V331326.R01.S.doc Version 5.2 Page 29 Chessington 3. YA9 4. YA17 5. YA19 6. YA22 7. 8. 9. 10. YA23 YA30 YA35 YA39 users, that may infringe upon their privacy, rights or freedom of movement should be recorded appropriately. This will ensure there is a record of the date and the people involved in such decisions. Risk assessments should provide enough detail to ensure staff fully understand what would happen if they did not reduce the risk. The detail should include clear action on what to do to minimise the risk. The provider should seek advice from a dietician to help come up with ways to encourage the use of fresh fruit and vegetables. The use of menus would help staff prepare appropriate foods. The provider should ensure there is enough food available in such quantities to enable people who live at the home to have “extra” should they require it. The monitoring of stock food in the house should be better to ensure there are enough choices of snacks available to people. The provider should make arrangements for dental and optician checks to be completed and monitored for all people living at the home, to ensure all health needs are met. The provider should seek advice on compiling suitable formats for those with communication difficulties to ensure there are systems that enable such people to communicate when they are unhappy. The provider should arrange training on the abuse awareness for all staff. The provider should review the frequency of carrying out personal laundry to ensure people living in the home do not live with the risk of bad odours in their bedrooms. The provider should continue to seek training for all staff that helps to meet the needs of the people living at the home. Quality assurance systems should include how they will meet their standards set, when the work should be completed and by whom. Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chessington DS0000061472.V331326.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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