Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 17/10/06 for Chessington

Also see our care home review for Chessington for more information

This inspection was carried out on 17th October 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff team work hard to care for service users in an inclusive, respectful and caring manner, this was observed throughout the inspection. The atmosphere in Chessington is cheerful and homely. A service user said they were listened to and felt their concerns would be dealt with properly. An appropriate complaint`s procedure helps assure service users, staff and relatives that any concerns raised would be dealt with effectively. The staff team are supported and guided with some good information in service users` files, although some improvements are needed. Service users` health needs are well met, monitored and are reviewed regularly with health professionals. This was confirmed by health professionals who provided feedback to the Commission prior to the inspection. Service users enjoy using local facilities for walks, shopping, trips to the seafront and having drinks and meals in cafes. A service user said their friendships and contact with relatives is encouraged and supported by the staff team. Service users are provided with a varied and healthy diet where choices of their preferred food are discussed and provided. Drinks and snacks are said to be freely available, although some areas need improvements. Some measures have been taken to protect service users` health, welfare and safety, through appropriate through policies and procedures, financial practices, care plans, some risk assessments, medication practices and some staff training, further work is needed to fully protect service users and staff. A service user expressed complete satisfaction in their bedroom and the facilities within the home. Chessington is a large home, which is decorated and furnished to a good standard, creating a warm and homely atmosphere. Service users are supported by an appropriate number of staff to meet their needs. Staff are provided with good verbal guidance from the provider to help them to understand and meet service users` needs, however improvements are needed in terms of staff training and service user information to ensure their needs are met effectively and safely. The provider reviews the care service users receive on a regular basis but some improvements are needed to ensure the home is run in their best interests.

What has improved since the last inspection?

A service user who has lived at the home since June 2005 was unable to describe what has improved since the last inspection but was completely satisfied with the care and support they received. Service users` medication, held on their behalf, is now stored in a secure cupboard, therefore protecting their welfare and safety. Information in some service users` plans of care and what is recorded about them each day has improved, providing staff with better information to help them to meet service users` needs, further improvements are still needed. The complaints procedure is now in a format suitable to the communication needs of service users. This helps service users understand how to complain and how concerns will be dealt with.The provider has introduced quality standards they work towards, which regularly reviews the care service users receive.

What the care home could do better:

Information provided to staff prior to service users` admission and while living in the home, needs to be improved. The information should be more descriptive to ensure it is clear to staff what service users` needs, goals and wishes are and what staff need to do to meet them. Any hazards to service users must be clearly assessed with clear actions on how staff can help to reduce any risks. The decision making process in the home needs to be improved to ensure decisions made on behalf of service users are discussed and agreed with community professionals. This is particularly important when some decisions infringe on service users` rights, choices and privacy. The home`s policies / risk assessments should reflect any agreements reached. Medication practices should be improved to ensure service users` safety and welfare is fully protected, including staff responsible for administering medication in the home receiving appropriate training. Recruitment practices and training for staff, including training for the provider and responsible individual, must improve to fully protect service users` health, welfare and safety. 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 service users.

CARE HOME ADULTS 18-65 Chessington Chessington 50 Marlpit Lane Seaton Devon EX12 2HN Lead Inspector Belinda Heginworth Key Unannounced Inspection 17th October 2006 09:00 Chessington DS0000061472.V307988.R02.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.V307988.R02.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.V307988.R02.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 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) Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Chessington DS0000061472.V307988.R02.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 22nd November 2005 Date of last inspection Brief Description of the Service: Chessington care home is part of the company Voyagers Ltd. It is registered to provide three service users with support and personal care to 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.V307988.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place from 9am until 1pm on a weekday. The provider, responsible individual, two staff members and the 2 service users currently living at the home, were present. One service user was able to talk with the inspector but one service user has extremely limited communication skills and was therefore unable to contribute verbally to the inspection process. Time was spent making observations throughout the inspection. Surveys were sent to a service user and staff prior to the inspection, comment cards were also sent to professionals who are connected to the home. At that time, only 1 service user lived at Chessington and one staff member worked there. The service user survey was returned (completed with the support of the staff in the home) and two comment cards from a GP and a health professional were returned. A staff survey was returned but the staff member no longer works at the home. All comments received were very positive about the home and the services. Prior to the inspection the manager completed a questionnaire, which provides information about service users, staffing, fees and confirms that necessary policies and procedures are in place. During the inspection the inspector “case tracked” the two service users living at the home. This means the inspector spoke with service users, made observations, spoke with staff and read service users’ records, starting from the admissions process through to the present. Medication practices were looked at and a tour of service users’ bedrooms took place. During the inspection, the inspector looked around the home and inspected other records. These included, the fire safety logbook, staff training records, staff rotas, menus, quality assurance records and recruitment files. What the service does well: The staff team work hard to care for service users in an inclusive, respectful and caring manner, this was observed throughout the inspection. The atmosphere in Chessington is cheerful and homely. A service user said they were listened to and felt their concerns would be dealt with properly. An appropriate complaint’s procedure helps assure service users, staff and relatives that any concerns raised would be dealt with effectively. The staff team are supported and guided with some good information in service users’ files, although some improvements are needed. Service users’ health needs are well met, monitored and are reviewed regularly with health Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 6 professionals. This was confirmed by health professionals who provided feedback to the Commission prior to the inspection. Service users enjoy using local facilities for walks, shopping, trips to the seafront and having drinks and meals in cafes. A service user said their friendships and contact with relatives is encouraged and supported by the staff team. Service users are provided with a varied and healthy diet where choices of their preferred food are discussed and provided. Drinks and snacks are said to be freely available, although some areas need improvements. Some measures have been taken to protect service users’ health, welfare and safety, through appropriate through policies and procedures, financial practices, care plans, some risk assessments, medication practices and some staff training, further work is needed to fully protect service users and staff. A service user expressed complete satisfaction in their bedroom and the facilities within the home. Chessington is a large home, which is decorated and furnished to a good standard, creating a warm and homely atmosphere. Service users are supported by an appropriate number of staff to meet their needs. Staff are provided with good verbal guidance from the provider to help them to understand and meet service users’ needs, however improvements are needed in terms of staff training and service user information to ensure their needs are met effectively and safely. The provider reviews the care service users receive on a regular basis but some improvements are needed to ensure the home is run in their best interests. What has improved since the last inspection? A service user who has lived at the home since June 2005 was unable to describe what has improved since the last inspection but was completely satisfied with the care and support they received. Service users’ medication, held on their behalf, is now stored in a secure cupboard, therefore protecting their welfare and safety. Information in some service users’ plans of care and what is recorded about them each day has improved, providing staff with better information to help them to meet service users’ needs, further improvements are still needed. The complaints procedure is now in a format suitable to the communication needs of service users. This helps service users understand how to complain and how concerns will be dealt with. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 7 The provider has introduced quality standards they work towards, which regularly reviews the care service users receive. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Chessington DS0000061472.V307988.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission process does not fully provide staff with the information they require to ensure service users’ needs can be fully met. EVIDENCE: Good information was provided prior to admission for one service user. A care manager completed an assessment of the service user’s needs and the home carried out additional assessments to ensure the home was suitable. The service user said they had visited the home on a number of occasions before moving in and felt happy that the home could meet their needs. The service user also said “I feel settled and happy living here”. There was no assessment available to inspect for a service user who has recently moved in to the home. The provider said this had been completed by them but was not in the file. No care management assessment was completed and most of the information came from the previous placement. The provider said they found most of the information from the previous placement was inaccurate. The service user had no verbal communication skills but the provider said many visits to the home took place before admission. This meant that the service user became familiar with the home. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 10 Discussions took place about the need to have assessments available to ensure staff are provided with enough information to understand and meet service users’ needs safely. Chessington DS0000061472.V307988.R02.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. Staff are provided with information to help them to meet service users’ needs, but improvements are needed to ensure they are met safely and consistently. Decisions made on behalf of service users are not always done in consultation with others therefore not ensuring the decisions are in service users’ best interests. The lack of clear risk assessments means that service users’ safety and welfare is not fully protected. EVIDENCE: One service user spoke happily about the care they received. They said the staff were kind and caring and said, “we have lots of giggles, I like the staff to pieces”. The service user said they attended care plan review meetings and their care plan was explained to them. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 12 Service users had plans of care produced by care managers. These related to general aims of the care needed, for example, to encourage independence and to provide 24-hour care. The home has provided information and guidance on how staff should manage and respond to service users. However, there were no descriptive aims relating to living in the home, or recorded actions on how staff should work to meet individual needs, for example, in one social services’ care plan it said to encourage independence in the kitchen but it did not describe how this should be carried out. The home had not produced a plan of care or clear actions on how this could be achieved. The service user said they made cups of tea on occasions but all food was made for them. The provider said they had been advised by an environmental health officer to discourage the service user in the kitchen because of potential cross infection. The care plan or risk assessment did not reflect this and the home had made no attempt to look at how to reduce the risk of cross infection without compromising service users’ independence. For example, when the service user does not have an infection the care plans / risk assessment should describe how they could use the kitchen in these instances, without compromising safety. A monthly report was written describing the progress made in one service user’s file. It did not necessarily relate to the information in the care plan, but did provide good information on how the service user was progressing. During the inspection a service user displayed some self-injurious behaviours. An agency staff was heard to say, “if you don’t stop that I’ll put your helmet on”. The care plan written by the care manager and the information recorded by the provider made no mention of using the helmet. The provider explained that during telephone conversations with the care manager and relatives the home had been encouraged to purchase a soft helmet to prevent the service user hurting themselves. The provider said they were not keen to use the helmet because they were aware that it was a form of restraint but found by “threatening” to use it, usually stopped the behaviour. It was agreed that any practices that may infringe upon service users’ freedom of movement should be discussed with other professionals, such as a Good Practice Committee. This would ensure that such decisions are made using a multi-disciplinary approach and were in the best interests of service users. It was also agreed that how the helmet is used should be monitored and reviewed regularly. The provider and responsible individual live on the premise at night. A listening device is used in one service user’s bedroom because of their health needs. This was not recorded in the care plan or agreed through a multi-disciplinary approach. The provider agreed to contact health professionals to find an alternative to the listening device. This would ensure the service user’s privacy was maintained. While waiting to find an alternative the provider agreed to discuss and agree the use of the listening device in a multi-disciplinary setting. This would ensure a number of professionals were aware and agree that using it is in the best interests of the service user. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 13 The home records daily events on a recording sheet and a handover sheet. Information about both service users is recorded on one sheet and sometimes includes personal information. These sheets ensure staff have information about what has happened on the previous shift. The record includes what foods have been eaten to ensure well balanced food is provided. The provider agreed to have separate sheets for each service user to work in accordance with the Data Protection Act, which protects peoples’ privacy in relation to information recorded about them. The home provides information on areas that may be a hazard to a service user, both in and out of the home, but the information does not describe clearly what action staff or the service user should take to reduce any risks. There were no risk assessments in place for the other service user; the provider intends to complete these soon. Discussions took place about the importance of completing these as soon as possible, given the complex needs and high risks to the service user. Chessington DS0000061472.V307988.R02.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, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from accessing the local community and taking part in appropriate activities. Service users’ rights are respected at all times and relationships with families are maintained. Service users benefit from a varied, well balanced and nutritious diet. EVIDENCE: One service user described outings they enjoyed, from shopping, lunches out, walks and trips into town. The service user had many friends in the local community and enjoyed seeing them when out at cafes or during walks along the sea front. The providers have encouraged the service user to bring friends home to visit but this has not happened yet. The home encourages the service user to be independent on their trips out. The service user did not want to join any educational activities or be part of any day centres. The other service user was unable to talk about their preferred activities and had not been living at the home for long. Staff said they were finding out the service user’s Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 15 preferences and had found they enjoyed going out for walks. The provider hopes to look for other activities in the future. One service user said staff were “always caring and polite”, they said staff “listened and were kind”. Observations during the inspection confirmed that staff acted in a respectful manner to one service user but to another service user were less so. For example, one service user has complex behaviours that can be challenging, some staff spoke in a child like manner, using expressions such as “good girl”, “wait a minute”, don’t do that”. The provider said the service user and staff were getting to know each other and were finding the best ways to communicate. Nevertheless an entry in one record said, “settled well but testing the boundaries”. The provider agreed that training in good communication would help in this area. (See section 31-36) A service user said they enjoyed the food provided by the home and confirmed they were offered choices each day. During the inspection service users were asked what they would prefer in their sandwiches for lunch. At the moment, the provider does not complete menus for the week ahead as the home has only two service users. The provider said, meals are discussed each day and agreements reached on what will be cooked. Records kept of foods eaten show a varied and healthy diet is provided. On the day of the inspection, a wipe clean board, displayed in the kitchen, described how many cups of tea a day and the times they could be given, for one service user. The staff and provider explained this decision was made to encourage the service user to try alternative drinks. However, during the inspection the service user displayed some self-injurious and challenging behaviour while trying to communicate they wanted tea. Discussions took place about decision-making processes involving other professionals and the need for clearly written care plans and guidelines for staff to follow. In addition, the need for training in managing people who can be challenging and who have limited verbal communication. (See section 31-36) Chessington DS0000061472.V307988.R02.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. Service users’ dignity and privacy is, on the whole, respected and they benefit from their health needs being closely monitored to ensure they are well met. Medication practices do not fully protect service users’ health and welfare. EVIDENCE: One service user said staff supported them to maintain their independence as much as possible. They said staff were kind and caring in how they provided personal care. Although care plans did not fully describe how personal care and support should be given, staff demonstrated a good understanding of service users’ needs. Positive feedback was received from a GP and a health professional who confirmed the home communicated well with health professionals and that they were satisfied with the care delivered to service users. One service user has complex health needs, which the staff monitor and support to avoid infections. Good records are kept of health needs, monitoring and reviews. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 17 The service users living in the home are unable to manage their own medication. Consent has been obtained from one service user 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 service user takes some medicines in liquid from, by mouth, through a syringe. The provider said other liquids that cannot be put in a syringe are sometimes put in drinks. The provider said this is done because, the medicine does not taste pleasant, and the service user often refuses it but requires it to stay healthy. The service user does not understand that it is in the drink and the provider has not checked with the pharmacy or GP that by doing this it does not change the effectiveness of the medicine. Discussions took place about consent issues when “hiding” medicines in drinks albeit for good intentions. It was agreed that this should be discussed and agreed with other professionals, such as Good Practice Committee, or with multi-professionals, to ensure they are aware and it is in the best interests of service users. The administration of regular medicines are currently being carried out by the provider and the responsible individual. Neither has received any training in the safe administration of medicines. The provider said they always administer the medicines together to ensure they are checked. During the inspection, one service user went out for a walk with two staff, medication that may have been required was taken with them, neither the agency staff or newly appointed staff had received training in the safe administration of medicines but the provider had explained how to administer it. Since the inspection, the provider has said that the agency staff had received training on administering this particular medication. The provider said medication training has been arranged for all staff in the next month. The medication administration records are different for each service user, although they were completed accurately, it could be confusing to staff, in the future, if more than one system is used. The provider keeps a record of medication received but not the quantities. Discussions took place about the importance of keeping a record of the quantities to ensure medicines can be audited and to ensure they have received the quantity required to meet the service users’ needs. The home keeps a stock of “over the counter” medicines and a policy of agreed Homely Remedies has been drawn up and agreed with the pharmacy. However, on the day of the inspection two “over the counter” medicines, in the medication cupboard, were not included in the Homely Remedy policy. It was agreed that to ensure these medicines are appropriate to give, with prescribed medicines, they must be included in the Homely Remedy policy. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 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. 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. Relatives and service users are assured they are listened to and complaints are dealt with appropriately. Service users are protected from abuse. EVIDENCE: After the inspection, the Commission received a concern from an anonymous member of the public about the possibility of staff shouting at service users. This was discussed with the responsible individual who will investigate the matter and feedback the outcome to the Commission. A service user said they felt they were listened to and any worries or concerns were dealt with. The providers had given the service user a pictorial complaint’s procedure but the service user did not like having it in their room. Feedback from a GP and a health professional confirmed they have received no complaints about the home. The agency staff and newly appointed staff were able to describe various forms of abuse and knew what to do if they suspected any. The newly appointed staff said the provider had talked through abuse issues and explained the policies relating to adult protection, this included the local Alertor’s Guide. The provider, responsible individual and member of staff have not received any formal training on adult protection issues but said this will be booked for the future. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 19 Service users’ finances are managed well with good records. A relative has power of attorney for one service user and monies are paid into a bank account for the provider to access on behalf of the service user. The provider keeps receipts of all monies spent. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 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. 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. Service users are provided with clean, safe and comfortable surroundings that meet their needs. EVIDENCE: The home is decorated and furnished to a good standard. One service user recently moved from a ground floor bedroom to one upstairs, to enable a new service user to move into the ground floor room. The service user said they were happy to move upstairs. Bedrooms are large, bright and airy and furnished to service users’ taste and preferences. 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 service users seemed relaxed in their surroundings. On the day of the inspection the home was clean and fresh. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 21 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 poor. This judgement has been made using available evidence including a visit to this service. Service users are supported by caring staff but improvements are needed in training to ensure service users’ needs are understood and met. Recruitment procedures do not protect service users. EVIDENCE: Until recently the home was run by the provider, responsible individual and the registered manager as only one service user lived at the home. A newly admitted service user, with complex needs, and the departure of the registered manager, has meant the provider has had to employ more staff. On the day of the inspection an agency worker and newly appointed staff were working at the home. The agency worker had been working there for almost two weeks and had a good level of experience of working with people with a learning disability and had received a good level of training through previous employments. The newly appointed staff had never worked as a carer before and was on their third week of working at the home. The provider and responsible individual were around to give guidance and direction. The agency worker said they had worked alone the previous week with the provider and responsible individual “popping” in. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 22 One service user said they were very happy with the new workers and appeared relaxed and confident around them. Another service user seemed less relaxed and displayed many signs of anxiety. It was hard to judge if this was due to staffing or settling in to their new environment. The provider said they were told by the agency that all checks had been completed on their workers. The provider had no written conformation from the agency. It was agreed this would be obtained to ensure service users are fully protected. No references had been obtained for the new staff. The provider said this had been left to the registered manager to complete but the manager had left the employment of Chessington during this process. The provider said they were about to complete this. A police check (CRB) completed by another employer and for another type of worker was on file. The provider and responsible individual did not realise that POVA checks must be completed for all new staff, before working in the home, which can only be obtained if a CRB has been applied for. The provider said the new staff never worked alone. However, the agency worker and new staff had worked unsupervised the previous week for periods of time. On the day of the inspection, the agency worker and new staff took a service user out for a walk. These poor recruitment practices do not protect service users from potential abuse. An Immediate Requirement notice was given to ensure service users were fully protected from potential abuse. The provider said they would stop the new staff working in the home immediately and train them, while waiting for the appropriate checks to be obtained. The providers have received limited training but are about to start a degree in health and social care. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 23 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. Service users benefit from a home that is managed well, but improvements are needed to quality assurance systems to ensure the home is run in service users’ best interests. Improvements to information relating to risks within the home and relating to service users will ensure service users’ welfare and safety is better protected. EVIDENCE: The provider and responsible individual now manage Chessington. They have always lived at the home and form part of the team who care for the service users. One service user spoke highly of the current management in the home and said they always involved them in decisions about all aspects of their life. The Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 24 provider and responsible individual were observed talking to service users in a caring and respectful manner and giving clear directions to staff. Until recently, the home employed a registered manager. No care staff were employed but the provider and responsible individual formed part of the team who cared for service users. Since the manager no longer works at the home and a second service user has recently moved in, the provider has employed a care worker. On the day of the inspection an agency staff and recently employed care staff were working in the home. The provider and responsible individual were also in the home providing guidance and support. Both staff said the management were very supportive and they provided good verbal information and guidance to help them understand and meet service users’ needs effectively. Both the provider and responsible individual said they have started a degree in health & social care. Discussions took place about the need to also attend training that is relevant to the needs of the service users and ensures their health, safety and welfare is fully protected. The provider said they have arranged training in the safe administration of medicines and other health & safety training. They said they hope to arrange further training that should help them to understand and meet the needs of service users, for example, understanding challenging behaviour, gentle teaching, adult protection and total communication. The provider and responsible individual regularly review the care service users receive, through good care plan reviews, consulting with service users 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 service users or GPs. The provider hopes to do this in the future and hopes to find a suitable way of seeking service users’ views, particularly those with no verbal communication skills. 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 service users. However, the plan does not 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 service users and staff safe. In this instance policies and procedures were in place. However, not all risk assessments have been put in place and some that were in place were in Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 25 need of updating, particularly those relating to service users. Discussions took place about the importance of completing and updating risk assessments to reflect the changing needs of service users, which will ensure staff are provided with up to date information to keep service users safe. Discussions took place about ensuring records protect service users’ confidentiality (See section 6 –10). 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 staff and service users’ welfare and safety is protected. Chessington DS0000061472.V307988.R02.S.doc Version 5.2 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 Standard No Score 1 X 2 2 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 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 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 27 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 YA2 Regulation 14 (1) (a & b) Requirement The registered person shall not provide accommodation to a service users at the care home unless, so far as it shall have been practicable to do so – a) needs of the service users have been assessed by a suitably qualified or suitably trained person; b) the registered person has obtained a copy of the assessment. (This relates to completing assessment on service user prior to admission and keeping the assessment on file) Timescale for action 30/12/06 Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 28 2 YA20 13 (2) The registered person shall make 30/12/06 suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (This relates to recording the quantities of medicines received into the home, all non prescribed medicines being included in the Homely Remedy Policy, appropriate arrangements for the use of “covert medication” and staff receiving suitable training) The registered person shall not employ a person to work at the care home unless, subject to paragraph 6, he has obtained in respect of that person the information and documents specified in – paragraphs 1 to 7 of Schedule 2. (This refers to obtaining satisfactory references and POVA checks before staff work at the home and ensuring they work under supervision and do not carry out personal care until a satisfactory CRB is obtained) An Immediate Requirement was made and a letter sent) 3 YA34 19 19/10/06 Chessington DS0000061472.V307988.R02.S.doc Version 5.2 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. Refer to Standard YA6 YA7 Good Practice Recommendations Care plans should include residents hopes and aspirations; and day-today goals. Daily records should reflect the care plan goals. Any decisions made on behalf of service users, that may infringe upon their privacy, rights or freedom of movement should be discussed in a multi-disciplinary setting to ensure such decisions are made in their best interests. Agreements should be recorded and reviewed regularly. (This refers to the use of a listening device at night, the “hiding” of medicines in drinks, restrictions in service users using the kitchen, restrictions in hot drinks and the use of a helmet) The home should seek training for all staff that helps to meet the needs of residents, including Protection of vulnerable Adults training. The management of the home should ensure they receive suitable training to meet the needs of service users and be up to date in their knowledge and skills. Quality assurance systems should include how they will meet their standards set, when the work should be completed and by whom. 3. YA35 4. 5. YA37 YA39 Chessington DS0000061472.V307988.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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.V307988.R02.S.doc Version 5.2 Page 31 - 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!