Inspection on 20/09/07 for Chester House Care Home

This inspection was carried out on 20th September 2007.

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

Chester House Care Home 03/05/06

Chester House Care Home 09/02/06

Chester House Care Home 08/08/05

Chester House Care Home 22/02/05

Chester House Care Home 18/08/04

Chester House Care Home 03/02/04

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Craignair

Alfred House Residential Care Home

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

CARE HOMES FOR OLDER PEOPLE Chester House Care Home 138 Chester Road Hazel Grove Stockport Cheshire SK7 6HE Lead Inspector Steve Chick Unannounced Inspection 20th September 2007 12:15 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 Chester House Care Home DS0000043970.V344027.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. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chester House Care Home Address 138 Chester Road Hazel Grove Stockport Cheshire SK7 6HE 0161 456 8500 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) assrafally@hotmail.com Mrs Bibi Toridah Assrafally Mr Mohedeen Assrafally Abhimanew Nookanah Care Home 14 Category(ies) of Dementia - over 65 years of age (2), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (14) Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Registered Manager must be supernumerary and not included in staff/resident ratios. The Registered Manager to achive the level of qualification required for Registered Managers by 2005. The ratios of care staff must be determined according to the assessed needs of service users and in accordance with guidance issued by the Department of Health. Domestic staff must be employed in sufficient numbers, with a minimum equivalent of one part time domestic appointed. The home is registered for a maximum of 14 service users to include: *up to 14 service users in the category MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age). *up to 2 service users in the category DE(E) (Dementia over 65 years of age). Service users can be under the age of 65 years but not under the age of 50 years in both categories 14 MD(E) and 2 DE(E). 3rd May 2006 4. 5. Date of last inspection Brief Description of the Service: Chester House is a care home providing personal care and accommodation for 14 people from the age of 50 years and upwards who have, or had, a mental illness. The home is located in the Hazel Grove area of Stockport. Local shops, cafes, restaurants, public houses, swimming baths and post office are approximately a 15 to 20 minute walk away. Other amenities, such as banks, churches, library and opticians, are a short car ride. Stockport town centre and motorway network are easily accessible by car. Hazel Grove train station is situated approximately a mile from the home. The bus service nearest to the home is infrequent and none are available on a Sunday, therefore a short walk is required to access an alternative service. The property is a modern detached house that has been extended. The accommodation consists of ten single rooms and two shared rooms spread over three floors; none of the rooms has an en-suite facility. There is one large combined lounge and dining room, and a conservatory. No passenger lift is available so the majority of service users must be able to climb the stairs. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 5 There is a fairly large garden to the rear of the house and a small car park to the front of the building. At the time of this report (September 2007) the fees varied from £347.00 per week to £392.00 per week. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. For the purpose of this inspection three service users were interviewed in private as was one visiting health and social care professional. Additionally discussions took place with the manager and two staff members were interviewed in private. The inspector also undertook a tour of the building and look to the selection of service user and staff records as well as other documentation including staff rotas, medication records and the complaints log. This key inspection included an unannounced site visit to the home. All key standards were assessed. This report also uses information gathered since the previous visit. This includes the annual quality audit assessment (AQAA) which is a selfassessment document designed to identify how a care home views its own practice. Service users spoken to were generally positive about the service offered at Chester house. One service user said it is very nice here … [I’m] treated very well. This service user also cited, as the best thing about the home, the company, both residents and staff. Staff were positive about the service they offered member of staff made the observation that carers know each other, service users know the staff and therefore are more open. What the service does well: What has improved since the last inspection? All recommendations made following the previous inspection has been either fully or partially addressed. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 7 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. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 8 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 Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 9 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): 3 and 6. Quality in this outcome area is good. Service users’ needs are assessed before moving to the home to ensure that their needs can be appropriately met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The self-assessment (AQAA) completed by the manager stated pre-admission assessment helps us to determine whether the prospective service users needs can be met and likewise they are appropriately placed within our service. A selection of service users files was looked at and all had documentary evidence that an assessment been undertaken before the service user had moved to Chester House. Evidence was seen of appropriate social services assessments being undertaken. Chester House does not offer intermediate care. Chester House Care Home DS0000043970.V344027.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): 7, 8, 9 and 10. Quality in this outcome area is good. Service users health, personal and social care needs are usually met by the consistent implementation of the homes policies and procedures. Staff practices also serve to promote the dignity of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A selection of service users records was looked at. All had a written plan of care. There was also documentary evidence of periodic reviews of and amendments being made to the plans. Daily records presented as being appropriately maintained. The homes AQAA identified an improvement in the last 12 months as including user friendly care planning based on increasing levels of participation from service users and/or their relatives. Documentary evidence of service user involvement was, however, inconsistent. Discussion with the manager Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 11 indicated that service users were involved, but a signature to confirm this was not always obtained. It is recommended that if the service user, or their representative, is unwilling or unable to sign to confirm their involvement the reason for this should be recorded. A visiting health and social care professional reported confidence in the quality of care offered at Chester House. They observed that practice in the home reflected an individual approach to service users and that service users were treated with respect and had their dignity upheld. Staff reported good personal knowledge of service users. The consistent staff team, relatively low numbers of service users, and the documentary and verbal systems in place to communicate information resulted in the care needs of individual service users being understood and met on a daily basis. One member of staff observe that the best thing about the home was that service users are well looked after, treated with respect and their dignity is maintained. Service users spoken to were mostly very positive about the care received. They were confident that staff listened to service users and knew their likes and dislikes. Chester House uses a pre-dispensed monitored dosage system for the administration of medication. The storage of medication was seen to be appropriate. Medication administration records (MAR) were predominantly appropriately maintained. However, frequent use of duplicate labels being fixed to the MAR sheets is not recommended. It was recommended that the manager discuss this issue with the relevant pharmacy which provides medication to the home. It was noticed that one service user had eyedrops which had not been administered for five days, as the medication could not be located. Even taking account of a weekend, five days to organise a replacement medication was too long. The manager reported that he periodically audited the MAR sheets and associated medication procedures but that this was not recorded. Documentary evidence was seen to confirm that service users have access to the full range of medical and paramedical facilities available in the community. Staff and service users who were talked to during this visit were confident that medical support would be obtained in a timely manner if necessary. Observations and discussion with service users, staff and a visiting professional all indicated that people living at Chester House were treated with respect and dignity. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14 and 15. Quality in this outcome area is good. An appropriate range of activities was available for service users, and visitors are welcome in the home, which enhances service users fulfilment and social stimulation. The provision of food to maintain service users health and wellbeing is good and service users are able to maximise their autonomy within the context of communal living. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was reported, both in the self-assessment (AQAA), by staff spoken to at this visit, and service users, that a range of social activities are available, depending on the individual needs, wishes and abilities of the service users. This included occasional outings for pub lunches. The home has a policy of allowing open visiting. Staff and service users who were asked all confirmed that visitors can come to Chester House at any Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 13 reasonable time. One service user spoken to expressed the view that visitors were made to feel welcome and, for example, offered a cup of tea and a biscuit. Service users and staff confirmed a high degree of autonomy and choice for service users, within the context of communal living. Service users confirmed that they could get up and go to bed when they wanted and access any of the communal areas. Service users were observed leaving the building and returning without the need for an escort. One service user cited, as the best thing about Chester House … Im my own gaffer. I come and go whenever I want. Service users spoken to were all positive about the provision of food. This included staffs knowledge of their individual likes and dislikes together with being given appropriate portions which varied between individuals. A record of meals provided was maintained, although this was not always effective at recording the choice of alternative to the main menu item. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 14 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): 16 and 18. Quality in this outcome area is good. Service users are protected from abuse or exploitation by the home’s policies and practices and are confident that any complaint they may have would be dealt with appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chester House has been found on previous inspection visits to have an appropriate complaints policy and procedure. This written procedure was not specifically looked at on this visit. Records of complaints presented as being appropriately maintained. Service users who were spoken to were confident that any complaint would be dealt with appropriately. One service user reported that they believed that staff paid attention to what service users said, saying I know they would listen. A visiting health and social care professional reported being confident that any complaint would be dealt with appropriately. Similarly they believed service users were protected from abuse and exploitation by the staff. Service users spoken to, reported that they felt safe at Chester House and that this applied equally to other service users who did not have the same level of communication skills. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 15 Staff who were interviewed demonstrated an understanding of the need to be vigilant in connection with abuse and exploitation. They also understood the whistleblowing policy and were confident they would use it if necessary. The manager reported that most staff had received some training with regards to protection of vulnerable adult issues. The manager was also confident in connection with the level of ‘protection awareness’ within the staff team. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 16 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): 19 and 26. Quality in this outcome area is good. The home is appropriately maintained, decorated and cleaned to enable service users to live in a pleasant, safe and hygienic environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this unannounced site visit, a tour of the building was undertaken. This included communal areas and a selection of service users’ bedrooms. There were no remedial issues identified in connection with the fabric of the building or furniture at this visit. There was clear evidence of service users ability to personalise their own rooms. One service user confirmed that they Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 17 could so do and said it is your home. Service users who were spoken to confirmed that they liked their accommodation. Chester House included a pleasant, well maintained and accessible garden. Service users confirmed they could use the garden, weather permitting and that there were, for example, occasional barbecues in the garden. The Commission had been contacted by letter since the previous visit, with a concern regarding the smoking arrangements at Chester House. The communal facilities consist of the dining room/lounge and a conservatory. To reach the conservatory you have to pass through the dining room/lounge. The conservatory is the designated smoking area as it has the most ventilation and is separated from the dining area and non-smoking lounge by a door. While not ideal, the current arrangements presented as being the most effective way of utilising the available space and catering for the needs of service users who wish to smoke, as well as non-smokers. The home was predominantly clean, tidy and odour free. This was reported as being the usual state of the building by service users, staff and a visiting professional. On entering the building there had been an unpleasant odour in the reception area. This was being dealt with using a mobile air purification machine. Staff reported the odour has been created shortly before this unannounced visit. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29 and 30. Quality in this outcome area is good. The numbers and skills mix of appropriately recruited staff promotes the independence, safety and well-being of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the staff Rota for the week beginning 10/09/07 was seen. This demonstrated that two members of staff were on duty between 08:00 -- 14:00 and 14:00 -- 20:00. Two waking staff were on duty between 20:00 -- 22:00 and 07:00 -- 0 8:00. Between 22:00 and 07:00 a member of staff was on waking duty and another was sleeping in. Discussion with the manager indicated that this arrangement was effective in meeting the needs of the service users. Information provided by the manager indicated that 70 of care staff held NVQ II or above. Documentary evidence of this was not sought at this visit. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 19 Staff confirmed that the manager was encouraging and supporting of staff undertaking training. Training opportunities were reported as being available both in-house and externally. A visiting health and social care professional confirmed that Chester House has a commitment to supporting its staff in training opportunities, including NVQ training. One staff file was looked at regarding training. This provided documentary evidence that that member of staff had attended several relevant training events in the preceding 12 months. The manager and staff reported a high retention rate of staff. This improves the opportunity for consistency of care for individual service users. The manager reported that only one member of staff had been recruited since the previous visit. This persons file was looked at regarding recruitment and vetting. All required checks appeared to have been undertaken appropriately. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35 and 38. Quality in this outcome area is good. The manager is competent to run the home, use the quality audit systems and implement the health and safety procedures for the benefit of service users and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection visit the manager had successfully completed the Registered Managers Award. Staff and visitors reported positively on his approach and supportive attitude. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 21 There was documentary evidence that quality assurance questionnaires had been sent out and returned by service users and other stakeholders in July 2007. No specific analysis or action plan which had been created as a consequence of this exercise was available at the time of this visit. Discussion with service users indicated that the majority view was that staff did take account of their views. It was reported that no money was held on behalf of service users at Chester House. When expenditure was made on their behalf this was recorded and individuals were subsequently invoiced. While this is generally a good method of minimising the potential for financial exploitation, its implementation at Chester House would be improved by better audit trail of receipts. Previous inspection reports have found standards of safe working practices to be good. A small sample of records relating to health and safety compliance of some equipment in the home was looked at and presented as being appropriately maintained. Staff confirmed the availability and compulsory use of disposable gloves and aprons to minimise the risk of cross infection. The visiting health and social care professional reported that they had observed safe working practices in the home. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 22 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 3 8 3 9 2 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP7 Good Practice Recommendations The registered person should ensure that there is good evidence to demonstrate that, within their capacity to do so, service users are involved in discussion and decision making in connection with their care needs. The registered person should ensure that consultation takes place with the pharmacist to ensure safest practise if being followed, as recommended by the Royal Pharmaceutical Society of Great Britain. The registered person must ensure that errors or omissions in the availability of service users’ medication are speedily resolved so that service users have their medication when it is required. The registered person should ensure that all ‘audits’ of the medication administration records are recorded to demonstrate effective managerial overview of the procedure. Effective records of food eaten by all service users should DS0000043970.V344027.R01.S.doc Version 5.2 Page 24 2 OP9 3 OP9 4 OP9 5 OP15 Chester House Care Home 6 OP33 7 OP35 be maintained so that the registered person can demonstrate appropriate nutrition and choice is provided. The registered person should ensure that an analysis of any questionnaires to service users is completed and used to inform a written action plan to demonstrate how service users’ views are used to improve the service. All records relating to expenditure on behalf of service users should be maintained to demonstrate transparency of financial actions. Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Chester House Care Home DS0000043970.V344027.R01.S.doc Version 5.2 Page 26 - 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. 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