Inspection on 16/04/08 for Chesswood Lodge

This inspection was carried out on 16th April 2008.

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

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

Other inspections for this house

Chesswood Lodge 06/11/08

Chesswood Lodge 26/09/06

Chesswood Lodge 02/11/05

Chesswood Lodge 10/05/05

Chesswood Lodge 02/09/04

Chesswood Lodge 28/05/04

Chesswood Lodge 05/06/03

Similar services:

1 Marten Road

Daubeney House

Three Gables

Deepdene Care Centre

Aldwick House

49 Glendale

Ferndale Residential Care Home

David Gresham House

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

CARE HOMES FOR OLDER PEOPLE Chesswood Lodge 49 Chesswood Road Worthing West Sussex BN11 2AA Lead Inspector Jan Aston Unannounced Inspection 16th April 2008 09:30 X10015.doc Version 1.40 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 Chesswood Lodge DS0000014445.V361379.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chesswood Lodge Address 49 Chesswood Road Worthing West Sussex BN11 2AA 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) 01903 230886 Chesswood Lodge Limited vacant post Care Home 14 Category(ies) of Dementia - over 65 years of age (14), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (14) Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named person in the category Mental Disorder (MD) over the age of 50 years. 26th September 2006 Date of last inspection Brief Description of the Service: Chesswood Lodge is registered with the Commission for Social Care Inspection to provide care for up to fourteen persons in the registration categories Mental disorder and Dementia over 65 years of age and includes one named person in the category of Mental Disorder over the age of 50 years. The property is situated in Worthing in a residential area close to a wellestablished park, local transport, railway and shops. The sea front, main shopping centre with all its amenities is approximately ½ mile away. The home is a large mature house with plenty of parking to the front and a secluded grassed garden to the rear. The accommodation comprises of 10 single bedrooms - 4 with en-suite facilities and 2 double bedrooms. There is a lift to the first floor but the home is not suitable to accommodate anyone in a wheelchair due to dimensions of the corridors. Chesswood Lodge Limited privately owns the service. Mrs Shoai, a director of the company is the registered responsible individual. The Manager’s post is currently vacant. The current fees for the home range from Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means that people who use this service experience adequate quality outcomes. This key inspection was undertaken following a safeguarding incident that is still under investigation. Some information from the Annual Quality Assurance Assessment form (AQAA) that was completed by the Provider in July 2007 has been used and referred to in this report. A visit was made to the home on Wednesday 16th April 2008 and seven hours were spent in the home. The Inspector looked around the home, examined a sample of records in relation to care plans, training, staff, complaints, accidents and Health and safety checks. Three members of staff and four people living in the home were spoken to privately during the visit. The Provider Mrs Shoai facilitated the inspection and called in several times during the day. The Deputy Manager also facilitated the inspection and was most helpful. What the service does well: What has improved since the last inspection? An assisted bathroom on the ground floor has been refurbished and has an assisted bath and a walk in shower. Some rooms have been re-decorated. Individual supervision for members of staff has been set up and provided regularly by the Deputy Manager. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 6 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. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A person’s needs are assessed prior to them moving into the home to ensure that the service can meet their needs and to ensure that the prospective service user and their relatives have sufficient information to make an informed choice about moving into the home. EVIDENCE: A sample of five care plans was examined during the visit to the home that included a person who was admitted to the home in March 2008. The care records for this person included a pre-admission assessment that had been completed on the 14/3/08 by the newly appointed manager and their line manager. The pre-admission assessment covers and records values, beliefs, feelings, thinking/communication, maintaining control re decisions/choices, activities, cultural beliefs, environment, behaviour, skin integrity, physical health, sight, mouth care dentures etc, social care, nutritional needs, personal Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 9 care, social profile. This provided good information to ensure the service could meet the person’s needs. Intermediate care not provided in this setting. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A person’s health and social care needs are assessed well and set out in an individual plan of care. The care planning, actions to be taken and guidance for members of staff does not support or safeguard a person with challenging behaviour. The principles of respect, dignity and privacy are put into practice. EVIDENCE: A sample of records relating to the needs of five people living in the home was examined. Each person living in the home has a personal file that contains all the information needed by the home to ensure the person’s needs are met. From the personal files that were examined it could be seen that a sufficient amount of information had been obtained about each person prior to and on admission. This included an assessment of a person’s physical condition, state of physical and mental health, an assessment of any potential risk to the person from the environment, behaviour or neglect. Risk assessments recorded potential risks from falling, being assisted to move by members of staff if necessary and from hot water. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 11 The care plans that were in place for each person in the sample identified the person’s needs, what the person and service hoped to achieve (goal), and what actions the service needed to take to ensure those needs were met. All of the care plans examined were fully completed and had been reviewed within the last six months. The care plans had been signed by the manager but not the person or their relatives; there was no indication that there had been any involvement from the person or their relative in the compilation of the assessment or care plan. Within the sample it was identified that two people had some form of challenging behaviour; aggression and suicidal tendencies. Their care plans gave very little information about this behaviour with no guidelines for members of staff about what signs or triggers may lead up to this behaviour, what action staff should take if witnessing this behaviour, what approach should be used or how members of staff should assist the person with that behaviour. Apart from the daily record there was no record of how often this behaviour occurs, what time and when and if there were any triggers for this behaviour. This means that there is no clear picture of this behaviour One of the people above had been prescribed medication to calm them down when they are in an agitated state. From speaking with members of staff it was clear that there were inconsistencies in when this medication should be given and what procedures should be followed. One member of staff said that they are not allowed to give this medication; another said that members of staff decide between them, another said they are instructed to telephone a trained nurse within the organisation before giving the medication. The trained nurse who may be telephoned may not know the person well and would not be witnessing their behaviour. This means that people living in the home with challenging behaviour may be at risk of receiving an unstructured and inconsistent approach from members of staff and at risk of medication being administered incorrectly and inconsistently. In the Social Services care plan for the same person it was recorded that they abuse pain relief. There was no evidence of clear guidance for how staff should manage this behaviour. A requirement has been made in this report for guidance and procedures to be put in place for each individual who may display challenging behaviour about how members of staff should work with the person when displaying this behaviour. A clear structured written plan should be put in place that guides members of staff on when medication in respect of behaviour should be given and the procedures they should follow. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 12 Assessments on admission to the home record a person’s physical state; weight, pulse, temperature, blood pressure, nutritional needs, skin condition, continence needs and a person’s illness/mental health problem. There was evidence that a person’s weight, food and fluid intake and continence was being monitored regularly. All people in the sample had recently seen an optician and chiropodist and a record of G.P. visits and advice was recorded. The care plans however did not specifically record how a persons health needs should be met and there was no evidence of health action plans or an annual health check for each person. This could lead to a person’s health need being missed, not monitored appropriately or appropriate specialist advice being sought. The storage and administration of medication was seen to be stored correctly. A monitored dosage system is used that is dispensed by a local pharmacy into blister packs. A record of when people living in the home were given medication and whether they took the medication was sampled. This was organised and had been completed correctly. A sample of training records for five members of staff was examined. Four out of the five members of staff in the sample had received training in the administration of medication in January 2006. A training session in the safe handling of medication had been arranged for the 17th April 2008 to update staff. People living in the home that were spoken with said that staff were kind and they respected their privacy and dignity. Care plans record a person’s preferred name. Screening was seen in sharing rooms to protect a person’s privacy and dignity. There is a payphone in the downstairs corridor for people living in the home to use. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in the home are able to express their decisions and choices and have opportunities to maintain independent living skills. Opportunities are available for people living in the home to go out regularly, have visitors and to be involved in activities within the home if they so wish. People living in the home receive a varied and balanced diet. EVIDENCE: The sample of care plans examined recorded a person’s family and social situation, their interests and cultural beliefs. They identified social stimulation as a need and stated action to be taken to meet this need. There was no evidence of a life history being in place for any person in the sample. It is recommended that a life history be completed where possible as this would enhance the information for members of staff and may be beneficial for the person living in the home if members of staff understood the person’s background and important place, people or events in their life. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 14 People spoken with during the visit told the Inspector that they went out the day before with the activities person to a local garden/park for a coffee and that they regularly go out to the shops and cafes and garden centres. The activities person currently comes into the home twice a week. The AQAA states that the organisation are going to increase this to four times a week. There is a mini bus available to take people out. When people don’t go out they undertake craft activities or play games. On the day of the visit a member of staff sat with a number of people in the afternoon for a painting session. It was noted that people living in the home are encouraged to be involved with washing up, laying tables and other independent living task according to their abilities. People living in the home have been supported to look after a hamster and two budgies. A person living in the home said that the Provider regularly brings her dog into the home and she takes it for a walk. The AQAA states that “visitors are Relatives, friends and other visitors are encouraged to visit when they want to; there are no set visiting hours. They are made welcome and offered tea and coffee. They are given a choice as to where they would like to be during the visit - bedroom, quiet corner or communal areas. Relatives may have meals with their loved ones at any time at no extra charge”. There were no relatives visting during the visit to the home. People spoken with confirmed that their relatives visit regularly where able. All eleven people living in the home were seen during the visit. It was observed at coffee time and lunch time that people were able to express their choices and these were respected by staff. There was an advocacy leaflet on the notice board in the home for CAREAWARE which is an advocacy service that the home is registered with. It was seen from the menu that people living in the home have a number of choices for their breakfast. A cooked breakfast is provided once a week. Menus are planned on a weekly basis rather than a four week menu plan and are different every week to provide variety. A menu is kept in the kitchen and the main meal of the day is written on the board in the dining area however this was not completed on the day of the visit. The main meal of the day is prepared at another care home that is owned by the same provider. It is brought over in special containers and cooked by the staff on duty at Chesswood Lodge. The Provider confirmed that this arrangement has been approved by the Environmental Health Officer. Staff spoken with confirmed that they have been trained in food hygiene. A member of staff that was spoken with said that they had beent trained and explained the procedure for the main meals and that the temperature of the food is taken before serving. A sample of five staff records was exmained for Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 15 evidence of food hygiene training. Two in the sample had received food hygiene training in 2006. The remaining three had not received this training. There were records kept of fridge, freezer temperatures and a cleaning rota for the kitchen, there were records also of a daily hazard check or faulty equipment completed on a daily basis. The main meal of the day was fish pie. The Inspector sampled the meal and it was hot, presented and cooked well. It was observed that all people living in the home came and ate in the dining room but chose where they sat and how long they sat for. One person had sandwiches at her request. People were assisted and encouraged to eat in a sensitive manner and their choice not to eat was respected. Members of staff spoken with confirmed that they tell people living in the home what is for available for the main meal in the mornings and if they choose not to eat this then they have food available to prepare jacket potatoes, salads, omlettes and sandwiches. They confirmed that they only have one person who follows a special diet as they are diabetic. Only one person required assistance with their meal and staff were available to give this assisstance. Nutritional assessments are undertaken on admission to the home. It was noted that where necessary a daily record is kept of what a person eats and drinks. On a persons daily records it could be seen that their weight is monitored monthly and action taken where a person is losing weight either through illness or poor appetite. People living in the home who were spoken with said that the food was good. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. If people have concerns they are protected by the accessible complaints procedure and efforts are made to put things right for individuals. The homes safeguarding adult policies and procedures did not ensure that a safeguarding adult incident was reported according to local procedures which puts people at risk of serious harm. EVIDENCE: The AQAA states that the complaints procedure is displayed on the notice board in the hall of the home and in the service users guide. During the visit it was noted that the complaints procedure was displayed on the notice board. The service user guide was also available in a document holder with a copy of the last inspection report under the notice board. The complaints record was examined during the visit to the home. The last complaint recorded was in 2005. A person living in the home that was spoken with said she would speak to the manager or deputy manager if she was not satisfied with anything. An incident occurred in the home on the 21/2/08 that resulted in a safeguarding allegation, referral and investigation. The incident was reported to the Commission under Regulation 37 but the incident was not reported appropriately through local multi-disciplinary safeguarding adult procedures. The investigation is not yet concluded and further changes to the homes procedures or actions by the commission maybe indicated. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 17 Following this incident the Provider was asked to provide details of actions that had been taken to ensure that any safeguarding allegation would be reported in line with the West Sussex multi-disciplinary procedures. An action plan was received from the Provider that stated; that “contact details of social services adult helpdesk will be displayed on the board in the office and all staff made aware of the number and procedures”. Members of staff spoken with during the visit confirmed that they had been made aware of the procedures and knew where to find the appropriate number to report any safeguarding adult matter. They said that NVQ training had provided them with a good awareness of recognising signs of abuse. A sample of five staff records was examined; this included training records. From this sample it could be seen that four out of the five had attended training in safeguarding adult procedures in 2007 one in 2003. It was confirmed that all members of staff would be receiving refresher training in safeguarding adult procedures. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and homely environment for people to live in. People living in the home and members of staff are unable to call for assistance, as the call alarm system is not in working order. EVIDENCE: An incident occurred in the home in February 2008 that raised concerns about the safeguards in place to prevent a person suffering scalding. This incident is still under investigation by the Environmental Health Department. The assisted bathroom on the ground floor has been refurbished since the last inspection. The Provider confirmed that a hot water thermostatic valve is fitted to this bath and sink and has been checked since the recent incident. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 19 The Inspector was informed that the home does not have a hoist available in the home and therefore in the event of an accident/incident or where a person’s condition deteriorates so they are unable to weight bear their needs currently cannot be met and may put the person or members of staff at risk. The accommodation for people living in the home is provided over two floors and there is a passenger lift to the first floor. The home is well maintained and all areas looked bright and clean. There is a secluded safe garden at the rear of the property with access through the kitchen door. The AQAA stated that the organisation employs a maintenance team to ensure that any matter requiring repair or redecorating is undertaken within good time. A maintenance book was seen in the home that was used as a communication method with the maintenance team so they are aware of any repair or matter requiring attention. The maintenance team employed by the organisation are responsible for undertaking safety checks within the property and on utilities and equipment. The records examined in relation to the health & safety of the premises demonstrated that the safety checks are undertaken on a regular basis and actions have been taken to safeguard people living in the home following the findings of the investigation into the recent incident. Within the home there is a separate lounge, lounge/dining room, ten single bedrooms, four with en-suite facility and two double rooms. There was evidence that screens are available in the double rooms in order that the privacy and dignity of each person is respected. A person who is employed by the home to undertake sleeping in duties also lives in the home. The person’s bedroom is located on the first floor within the same area as residents’ bedrooms. The person uses the staff toilet that is located on the same floor but shares the bathing/showering facilities. As part of this person’s employment they are able to share the home’s food and eat the meals that are prepared as they so choose. This person is employed to carry out six sleeping in duties a week, is out of the home most days and their bedroom door is locked. This information should be included in the Statement of Purpose so any new person admitted to the home and their relatives are aware of this arrangement. Peoples’ rooms have been personalised with their personal possessions and some of their furniture and all rooms looked different. Locks are fitted on bedroom doors and keys are available to people living in the home if they wish to have one. The call alarm system in the home was found not to be working and had been disconnected. Members of staff spoken with confirmed that they were aware that estimates had been obtained to purchase a wireless system. The Provider Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 20 confirmed that a new call alarm system would be purchased as soon as possible. During the visit most people living in the home were seen to be in the lounge and dining areas for the most part of the day. The Deputy confirmed that procedures had been put in place to ensure that all people living in the home are checked regularly throughout the night. A requirement has been made in respect of this matter. There are two bathrooms on the first floor, one of which is out of use due to continuing investigation and one assisted bathroom on the ground floor. A laundry is situated in a small building outside of the kitchen and this looked fit for purpose. A separate smoking room is also located in the same area. Members of staff confirmed that when people living in the home wish to smoke they are accompanied by a member of staff. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff meets the needs of people living in the home. People are safeguarded by the home’s recruitment policy and practices. The needs of people living in the home may not be fully met, as members of staff have not received training in mental health illnesses. EVIDENCE: Currently as there are only eleven people living in the home the staffing ratio has been reduced recently from three to two members of staff in the morning and afternoon. All members of staff spoken with said that this was manageable as some people living in the home were quite independent with their personal care. All staff said that at night there is usually a person sleeping in and one person awake; when the night sleeper is not on duty there are two people awake. There have been no new members of staff employed in the last year. A sample of staff records was examined. The records were organised and included all the relevant information about each person. Where necessary there were records of the state of a person’s residency in the UK and it was clear the date this leave expired. A record was seen of the date a person commenced work, the date the criminal record had been applied for and the date the criminal record had been received with the disclosure reference numbers. All had references in place. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 22 The AQAA states that all members of staff have obtained National Vocational Qualifications at level 2 and some have achieved or are working towards Level 3. There have been no new members of staff employed in the last year so the induction programme was not assessed. The sample of training records examined demonstrated that three members of staff in the sample had undertaken a considerable amount of training since working in the home. This included infection control, diabetes, epilepsy, bereavement, dementia, physical interventions and challenging behaviour. Two members of staff in the sample who worked at night had undertaken training in good night care in 2006. The other two members of staff in the sample had not undertaken this amount of training. There was no evidence that the person who undertakes most of the sleeping in duties had undertaken training in first aid, infection control or good night care. There was no evidence available of an individual training needs assessment for each member of staff or a an assessment of the skill mix and training needs of the staff team as a whole. Apart from training in dementia members of staff have not been trained in mental health illnesses and as the registration for the home is mental disorder this should be in place. There was a notice in the office that a training session in the safe handling of medication was being held on the 17/4/08. Apart from this there was no evidence of a planned training programme for members of staff at Chesswood Lodge for the forthcoming year based on their training needs. A requirement has not been made in respect of training as the organisation has supported all staff at Chesswood Lodge to achieve NVQ level 2 or above. However a training needs assessment should be undertaken for every member of staff, for the staff team as a whole and a training plan be developed that incorporates the identified training needs and includes training in the awareness of mental illnesses. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home are not safeguarded from harm and the organisation cannot ensure safe working practices for members of staff as the not all members of staff had received training in the mandatory Health & Safety topics. EVIDENCE: Currently the manager’s post is vacant. A new manager has been appointed but it not yet registered with the Commission. The Provider undertakes regulation 26 inspections. Copies of the regulation 26 reports were available in the home, were seen and confirmed that they are undertaken as required. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 24 The AQAA states that questionnaires are sent to people living in the home, relatives and professionals to obtain their views of the service and people living in the home are regularly spoken with to see if any improvements are required. The Inspector was informed during the visit that questionnaires have been sent out but not recently so there was no evidence to examine. This inspection has highlighted the need for improvement in the area of guidance for staff on care plans in respect of challenging behaviour, the recording of actions to be taken to meet people’s health needs, health action plans and training needs in the mandatory health & safety topics. The quality assurance system within the home should have identified improvements in these areas. The Inspector was informed that the home does not manage the finances of any individual living in the home. Small amounts of money may be held for hairdressing or chiropody or personal items. Currently this only applies to one person and it was noted that records of any transaction is recorded. It was seen from care records that a record is made of a person’s personal possessions on admission to the home. The Deputy Manager informed the Inspector that she initiated supervision arrangements with members of staff and has been providing this regularly. Two members of staff spoken with confirmed that they have received individual supervision with their manager and an annual appraisal with the Provider. Documentation relating to the Health & Safety of the premises was examined during the visit to the home. The documentation demonstrated that checks on utilities, portable appliances, lift, hoists have been undertaken. The home meets the requirements of the fire regulations. A fire risk assessment for the premises is in place and was reviewed June 2006 and an assessment of fire hazards in the home was undertaken in January 08. Fire fighting equipment annual safety inspection was undertaken October 2007. There was evidence of regular checks on emergency lighting, means of escape and the fire alarm. Staff had received fire instruction in October 07 and in January 08. General risk assessments were in place in respect of the environment in relation to falls, radiators, window restrictors, electricity, hot water, chairs, kitchen, front doors coded lock, lift, cellar, smoking, medication, garden, pregnant workers, back care. The risk assessments had been reviewed on the 11/1/08. The Provider confirmed that a qualified person had checked the hot water outlets for safety since the recent safeguarding incident. It was observed that the bathroom where the incident took place is now locked and not used. Another bathroom on the first floor with a shower facility is still in use but not generally used by people living in the home, as they require the assistance of a hoist chair to lower them into the bath. Some rooms have a shower en-suite but an assessment is made first before the person is allowed to use it; if they Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 25 are unable to then the water is disconnected. Risk assessments were undertaken on the 6/3/08 for all residents in respect of hot water and risk of scalding and are kept in the care records. The downstairs bathroom is an assisted bath with hoist chair. The Provider confirmed that there is a thermostatic valve fitted to this and the plumber had checked that this was working safely. The Deputy Manager confirmed that the maintenance person undertakes checks on the temperatures of hot water. A sample of five staff records were examined for records of training in the mandatory health & safety topics; moving & handling, fire, first aid, food hygiene and infection control. From the sample it could be seen that only two out of the five had received first aid training in 2007; the night sleeper had no record of any first aid training, only two out of the five had received training in food hygiene, only three out of the five had received training in moving & handling, only three members of staff had received training in infection control. From this evidence it can be seen that not all members of staff have received training in the mandatory Health & Safety topics and this could put people living in the home and members of staff at risk. A requirement has been made in respect of this. Chesswood Lodge DS0000014445.V361379.R01.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 3 X 2 Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15. Requirement The Provider must ensure that care plans provide detailed written guidance on how members of staff should support a person with challenging behaviour. The Provider must ensure that care plans record actions to be taken to meet the health needs of people living in the home and that a health action plan is put in place that ensures each person receives an annual health check. The Provider must ensure that care plans provide detailed guidance and procedures in respect of giving medication to alleviate a person’s agitation or challenging behaviour. A call alarm system must be provided in the home and must be working at all times. Timescale for action 04/08/08 2. OP8 12 (1) 04/08/08 3. OP10 12 (2) 04/08/08 4. OP22 13 (4) 04/08/08 5. OP38 18 (1) (a) The Provider must ensure that all 04/08/08 members of staff receive training in all of the mandatory health & safety topics and this training is kept up to date. Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chesswood Lodge DS0000014445.V361379.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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