CARE HOMES FOR OLDER PEOPLE
Chester House 138 Chester Road Hazel Grove Stockport SK7 6HE Lead Inspector
Jackie Kelly Announced 8 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Chester House Address 138 Chester Road, Hazel Grove, Stockport, SK7 6HE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 456 8500 01625 267468 assrafally@hotmail.com Mr M & Mrs B Assrafally Ms A Nookanah CRH - Care Home 14 Category(ies) of DE(E) - Dementia over 65 (2) registration, with number MD(E) - Mental Disorder over 65 (14) of places Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The registered manager must be supernumerary and not included in staff:resident ratios. The registered manager to achieve 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) and up to two 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 two DE(E). Date of last inspection 22 February 2005 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 is 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 consisits 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 residents must be able to climb the stairs. There is a fairly large garden to the rear of the house and a small car park to the front of the building. Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an annual announced inspection, which took place over one day. Time was spent talking with the manager, the owner Mr Assrafally, the care workers and residents. Care plans, staff files, and drug administration records were looked at. A tour of the home took place. Questionnaires were sent to the home for the residents and relatives to complete; at the time of writing this report one resident and four relatives questionnaires had been completed and returned to the Commission. The District Nursing team and one of the GP’s had completed a questionnaire. All of the questions were answered positively and no one had made a complaint. There were a small number of comments; ‘the home seems very clean and homely’; ‘Vijay (manager) appears to run a ‘good ship’ and ‘I am happy with the care provided’. What the service does well: What has improved since the last inspection?
The owner has provided training for all the staff particularly aimed at caring for people with mental health problems and dementia for which the home is registered. The type of food provided on the menus has improved with more variety and choices at breakfast and tea. The main meal of the day is at lunchtime and is a
Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 6 set meal. However should someone not like what is on the menu an alternative would be offered. All the radiators had been covered to ensure that residents were protected from the risk of burns. 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. Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5. Standard 6 is not applicable. Residents and their relatives were offered written information which told them what the home provided. The staff team were able to meet the needs of the residents. EVIDENCE: A service user guide and statement of purpose was available for residents and their relatives; copies were displayed in the entrance hall. There were social work assessments, the homes own assessments and contracts; all of which gave the relatives, residents and care workers facts about the home and the care needs of the resident. The manager visited prospective residents before they were offered a place at Chester House. All residents were given the opportunity to visit the home before making the decision to move in for the trial period of six weeks. Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11. The owners and care workers met the health care needs and privacy of the residents. Medication was handled safely. EVIDENCE: Since the previous inspection a new form had been introduced for use as a care plan. These care plans are easy to read and serve as a quick reference guide to the care needs of the residents. Those residents who have been at the home for a number of years also had a more in depth care plan, which complemented the new forms. Risk assessments specific to any special needs of the residents must be written and included with the care plan. The residents who were spoken with said that they were happy with the care they received; one resident said that they ‘like living here’; ‘dinner was lovely’; ‘everything ok’. The inspector observed the care workers respecting the residents’ rights to privacy by knocking on bedroom doors before entering. Medication records were looked at and had been completed properly. None of the current group of residents manages their own medication.
Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 10 The care workers had received training on care of the dying. Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15. Residents were given choices so that they could maintain control over their daily life as far as their capabilities would allow. EVIDENCE: The manager had given out resident satisfaction questionnaires. The inspector saw the completed questionnaires. The majority of the answers indicated that the residents were satisfied with the care they were receiving. There were two minor comments regarding the food, which had been noted by the manager. However on the day of the inspection the residents who were spoken to said they were happy with the food. It was a set menu for the main meal of the day but should anyone not like what was on the menu they could have an alternative. Questionnaires provided by the Commission for Social Care Inspection were on the table next to the visitors’ book in the entrance hall for people to take and fill in if they wished. A small number had been completed and returned to the Commission all of which showed that they were pleased with the running of the home and the care and attention the residents received. Each resident was allocated a care worker known as a ‘key worker’ with whom the resident could talk to on a personal and private level. Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 12 Friends and relatives were welcomed at the home at all reasonable times of the day and evening. Residents are encouraged to maintain contacts with friends and services in the community. Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18. Residents are protected through the complaints procedure, training and daily monitoring of care workers. The manager requires further training in adult protection procedures. EVIDENCE: The service user guide had a section on how, and to whom, residents could complain. None of the residents or relatives with whom the inspector had contact with had any complaints. The home was not responsible for any of the residents’ finances apart from a small amount of money for daily items such as hairdressing; a record was kept. The owner had given training on the protection of vulnerable adults to the care workers. The policy and procedure to be followed should abuse of residents be suspected or witnessed needs to be amended and include a section about the Protection of Vulnerable Adults (POVA) register. It is recommended that the manager attend one of the courses provided by Stockport Social Services on the protection of vulnerable adults. Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26. The home was maintained, decorated, furnished and fitted to a minimum standard however hygiene standards in some areas of the home could be improved. EVIDENCE: The inspector looked round home, which was maintained, decorated and furnished to a minimum standard. One of the bedrooms did have a slight odour problem. Should this problem get worse new carpet and possibly furnishings may be necessary. Pipe work in downstairs toilet needed painting or preferably boxing in. There were enough bathrooms and toilets. The bedrooms that were seen by the inspector were satisfactorily furnished. Some of the bedrooms were more personalised than others depending on the individual residents’ choice. There is no passenger lift therefore the majority of the residents need to be able to climb stairs in order for them to reach their bedrooms.
Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 15 Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30. The recruitment and selection methods used ensured that suitable care workers are employed. Experienced care workers look after the residents. EVIDENCE: The rota’s seen by the inspector showed that there were sufficient numbers of care workers on duty to meet the needs of the residents. Many of the care workers had been working at the home for a number of years. A small number had a National Vocational Qualification (NVQ) and others were working toward completing their NVQ Level 2 by the end of 2005. The owner who is a qualified nurse has provided training on caring for people with mental health problems including dementia to all the care workers. Other training such as; moving and handling, infection control and food hygiene had taken place. The two care workers who were spoken with were happy with the care the residents received and the general management of the home. Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35,36,38. The home was run for the residents by a staff team who were experienced and were aware of the health and safety of residents. EVIDENCE: The owners and manager have many years of experience. However the manager has no recognised social care or management qualification. However he is presently taking a National Vocational Qualification (NVQ) Level 4 in Care, which is to be completed by the end of 2005. Once this qualification has been achieved he will undertake the management units of the Registered Managers Award. The residents’ views and opinions were sought through talking with the manager, key-workers, resident meetings and questionnaires. From the feedback gained from residents, relatives and other healthcare professionals the owners and manager must produce a yearly quality assurance report. This report must be sent to the Commission for Social Care Inspection, and a copy be made available to residents and relatives.
Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 18 A staff appraisal had been done with all the staff team. This will lead onto staff supervision. Each care worker had a personal objective plan. The home was not responsible for any of the residents’ finances other small amounts of ‘pocket money’ for which a record was kept. The home had produced a written annual development/building maintenance programme, which was shown to the inspector on the day of the inspection. The fire safety risk assessment is due to be done by a consultant fire safety professional within the last two weeks of August. The health and safety of the residents and workers was overseen by the owner/manager. Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 2 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 Standard No 16 17 18 Score 3 3 2 2 x 2 x 3 3 x 2 Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 20 Yes 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 9 Regulation 13 (4 - c) Requirement The registered person must ensure that specific risk assessments are in place as required. The registered person must monitor the bedroom that has an odour problem and take appropriate measures. The registered person must produce a report from the analysis of all surveys done. A copy of the report must be sent to the Commission and a copy made available to residents. The timescale of the 1 August 2005 was not met. Timescale for action 18 September 2005 18 March 2005 18 November 2005 2. 26 16 (2 - k) 3. 33 24 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 18 Good Practice Recommendations The registered person should include in the policy and procedure for the protection of vulnerable adults information about the Protection of vulnerable Adults (POVA) legislation. The manager should also attend a training course on the protection of vulnerable adults
F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 21 Chester House 2. 3. 4. 19 31 38 procedures under the new legislation. The registered person should seek to improve on the current standard of decoration. The registered person must ensure that the manager completes the National Vocational Qualification Level 4 by the end of 2005. The registered peson should ensure that the fire protection consultant visits the home by the end of August and provides the fire risk assessment as required under the Fire Safety Regulations. Chester House F54 F04 chester house A s43970 v236501 080805 stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 2nd Floor Heritage Wharf Portland Place Ashton under Lyne, OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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