CARE HOMES FOR OLDER PEOPLE
Chester House Care Home 138 Chester Road Hazel Grove Stockport Cheshire SK7 6HE Lead Inspector
Jackie Kelly Unannounced Inspection 9th February 2006 15:45 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.V279124.R01.S.doc Version 5.1 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.V279124.R01.S.doc Version 5.1 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 Anhimanew 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.V279124.R01.S.doc Version 5.1 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 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). *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). 8 August 2005 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 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 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 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 Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place late afternoon. Time was spent talking with the manager Mr Vijay Nookanah, residents and care workers. Also present during the inspection was the National Vocational Qualifications assessor and the District Nurse. Care plans, accident records and drug records were looked at. Two residents returned to the home with their relatives after being out for the afternoon. Both of these are regular outings, which are encouraged and supported by the staff team. On the day of the inspection there were thirteen people living at the home. There was one vacancy in a shared room. A tour of the ground and first floors took place, which included bathroom, dining room, lounge, kitchen and bedrooms. The home was reasonably clean and homely with bedrooms reflecting the residents’ personality. Not all the standards have been looked at during this inspection as they were found to be met and satisfactory during previous inspections. Neither the home nor the Commission for Social Care Inspection had received any complaints. What the service does well: What has improved since the last inspection?
Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 6 A small number of requirements and recommendations were made during the previous inspection of August 2005. The majority of which had been implemented. Those that were not met are contained again in this report. The manager had done risk assessments where necessary and had set up a system for recording falls. This would allow the manager and care workers to monitor residents in order to try and prevent any serious injuries occurring. One of the bedrooms had an odour problem even though regular cleaning took place. The owner had purchased two air purifiers, in order to reduce the effect of any unpleasant smells. Bedroom one had been redecorated and a new carpet had been bought. The registered manager had completed his National Vocational Qualification Level 4 in care. The manager was waiting for funding with the aim of taking the Registered Managers Award, which he hopes to start April 2006. The owner had employed a fire protection consultant to do a fire risk assessment of the home so that the home complied with the Fire Safety Regulations. What they could do better:
The owner must produce a quality assurance report a copy of which must be sent to the Commission for Social Care Inspection and made available to the residents and their relatives. The purpose of this report is to provide information on the previous achievements of the home and future development. Analysis of the residents’ questionnaires and the owner’s responses should be included along with a summary of what has taken place over the past twelve months and what is planned such as refurbishment and replacement of equipment and fittings. The previous two timescales of August and November 2005 had not been met. A new timescale of the 31 March 2006 has been given failure to comply with this date may result in further action being taken. All the care plans should be of the same standard and include a photograph of the resident. The policy and procedure for the protection of vulnerable adults must have information on how to contact the Adult Protection Unit. The manger should also attend a training course on the protection of vulnerable adults to ensure that the correct procedures are followed should there be an allegation of abuse and to protect the residents. This was a recommendation in the previous inspection report of August 2005. Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 7 The system for storing the accident records must comply with Data Protection Legislation. 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 Care Home DS0000043970.V279124.R01.S.doc Version 5.1 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.V279124.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5. Standard 6 is not applicable. Information was available which told residents and relatives what was available. The staff team were able to meet the needs of the residents. EVIDENCE: No new resident had been admitted to the home since the previous inspection of August 2005. There was one vacancy in a shared room. The manager said that any new person referred to the home would only be admitted after receiving a social care assessment; had been visited in his/her home or hospital ward and had been to Chester House prior to admission. A service user guide was available for all prospective residents, which would tell them about the home. Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. The owners and care workers met the health care needs and privacy of the residents. EVIDENCE: A small sample of care plans was looked at. The care plan of the last person to be admitted had no photograph and the more in depth care plan that all the other residents had was not available. The manager should produce the more detailed care plan as it complements the summary sheets, which were being used. None of the residents who were living at Chester House on the day of the inspection were in charge of their own medication for various reasons such as; not wishing to take the responsibility or mental health problems. The records were looked at and found to be satisfactory. The district nurse visited the home during the inspection. Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 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 the following 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: Two of the residents were out the time of the inspection, one out with relatives and a second attending a church fellowship class. The manager asked all the residents what they wanted for tea from a choice of a cooked meal or sandwiches. The main meal was served at lunchtime. One resident did not eat her meal at lunchtime so the meal was saved for tea. The conservatory had been set-aside for those residents who smoke. All the residents who were spoken with on the day of the inspection were happy with the care they were receiving. The majority of residents had their meal sitting at the dining table however one person ate the meal in their room. Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 16,17,18. For the most part residents were protected. However training and policies were incomplete. EVIDENCE: The service user guide (which was given to all residents or their relatives) had a section on how and to whom residents could complain. The home was not responsible for any of the residents’ finances. There had been no complaints received either by the owners or the Commission for Social Care Inspection. 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. The owner had given training on the protection of vulnerable adults to the care workers. However it is recommended that the manager attend one of the courses provided by the Stockport Adult Protection Unit on the protection of vulnerable adults. This was a recommendation in the previous report of August 2005. Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 19,20,23,24,25,26. The home was maintained and decorated to a minimum standard and for the most part was reasonably clean and hygienic. EVIDENCE: The ground and first floor, which included the lounge/dining room, bathroom and a small number of bedrooms, were looked at. The bedrooms were satisfactorily furnished with some more personalised than others depending on the residents’ choice. Bedroom one had been decorated and a new carpet put down. The home had purchased two air purifiers in order to minimise household odours. The home did not have a lift therefore as there are a limited number of bedrooms on the ground floor residents must be able to climb stairs. To overcome this problem the owner had consulted with the fire service with a view to installing a stair lift.
Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30. Experienced and suitable care workers were employed to look after the residents. EVIDENCE: A member of staff who was in the process of taking a National Vocational Qualification (NVQ) Level 2 was having a tutorial with her NVQ assessor on the day of the inspection. The assessor was pleased with the work that had been presented. The majority of staff had worked at the home for many years. Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,37,38. 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 manager had completed his National Vocational Qualification Level 4 in care. He was waiting for funding to complete the Registered Managers Award, which he is hoping to start April 2006. The accident record was looked at. The system for storing completed forms did not comply with the Data Protection Legislation. The manager had put in place a system for recording and monitoring falls. The owner and manager must produce an annual quality assurance report. A copy of this report must be sent to the Commission for Social Care Inspection
Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 16 and made available to the residents and their relatives. As part of the Quality Assurance Report a plan of decoration and renewal of furnishings etc for the year ahead should be included. This was a requirement in the previous inspection report of August 2005 with a timescale of November 2005. Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 17 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 3 x 3 3 3 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 3 18 2 3 3 x x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x x x 3 2 Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? YES 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 17 Requirement Timescale for action 31/03/06 2 OP33 24 3 OP38 17 The registered person must ensure that there is a photograph of residents available and all care plans are of the same standard. The registered person must 31/03/06 produce a quality assurance report, which includes an analysis of the questionnaires. A copy of the report must be sent to the Commission and a copy made available to residents. The timescale of the 1 August and 18 November 2005 was not met. The registered person must 31/03/06 ensure that the accident records are kept in accordance with Data Protection Legislation. 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 Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 19 1 OP18 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 procedures under the new legislation. This was a recommendation in the previous report of August 2005. Chester House Care Home DS0000043970.V279124.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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