Inspection on 25/01/08 for Chestnut Road

This inspection was carried out on 25th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chestnut Road 27/05/06

Chestnut Road 09/09/05

Chestnut Road 12/04/05

Chestnut Road 23/11/04

Chestnut Road 07/09/04

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

CARE HOME ADULTS 18-65 Chestnut Road 44 Chestnut Road West Norwood London SE27 9LF Lead Inspector Sonia McKay Unannounced Inspection 25th January 2008 09:30 Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut Road Address 44 Chestnut Road West Norwood London SE27 9LF 020 8761 3689 020 8761 9457 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) Caretech Community Services Limited Kelly Field Care Home 13 Category(ies) of Learning disability (13), Physical disability (13) registration, with number of places Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of the service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Physical disability - Code PD The maximum number of service users who can be accommodated is: 13 29th August 2007 2. Date of last inspection Brief Description of the Service: 44 Chestnut Road is one of a number of residential homes owned and managed by Caretech. It provides care and accommodation for thirteen younger adults with learning disabilities. It is divided into two separate units. The ground floor has eight bedrooms and is suitable for people with learning and physical disabilities. The first floor has five bedrooms. The second floor provides a supported living service that is not part of the registered service. All units have appropriate numbers of bathroom and shower facilities and have their own kitchens and communal areas. A passenger lift is available. At the rear of the premises is a wheelchair accessible garden, part laid to a lawn and a paved area. The home is located close to the main shopping area and public transport links in West Norwood. There is limited parking available on the driveway and on the roadside. Chestnut Road DS0000055761.V347687.R02.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 the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out over three days by one inspector. There have been two random inspections of the service since the last key inspection in May 2006. These were conducted in February and August of 2007. Reference is made to the findings of these additional visits in this report. The methods used to assess the quality of service being provided include: • • • • • • • • • • • • Discussion with the newly appointed home manager Examination of the Annual Quality Assurance Audit document completed by the registered manager (this document is sometimes called an AQAA and it provides the Commission with information about the service) Discussion with people currently living in the home Observation of the care and support they receive Discussion with a visiting health professional Discussion with two people who advocate for some of the people living in the home Discussion with staff working in the home A tour of the premises Examining records of the care provided to four of the residents Examining records relating to staffing and training Examination of the way medicines are handled by staff in the home Discussion with two placing authority care managers The Commission would like to thank all who kindly contributed their time, views and experiences to this inspection process. What the service does well: There is an informative statement of purpose and an accessible guide for prospective residents. Residents receive the assistance they need to make decisions about their every day lives. Risk assessments are detailed and have been reviewed recently. This keeps people safe. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 6 There is opportunity for people to take part in age, peer and culturally appropriate activities. Residents are part of the local community and they have opportunities to engage in leisure activities and to maintain their personal and family relationships. The home is well adapted, clean and comfortable. Communal space is restricted but there is an accessible rear garden. Staff check the home regularly to ensure that things are safe for residents. Many visitors to the home said that staff are warm and friendly and that they have good relationships with the people living there. Most staff have worked in the home for a number of years and know the residents well. What has improved since the last inspection? What they could do better: There should be more information for prospective residents about the restricted accessibility of the ground floor kitchen and of the care arrangements of people who are considering using the service on a respite basis. There is insufficient information about the contractual obligations that the service has to each of the current residents. This means that the current Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 7 residents cannot be assured that they are receiving a service in accordance with their stated needs and contract. As all residents need support to access the community more must be done to ensure that there are an adequate number of staff on duty to support the activities planned for each resident. More must be done to ensure that there are adequate food supplies in the home at all times. Staff must keep better records of what people eat, and in some cases drink. Staff shortages and unfamiliar routines for newer residents have made providing good personal care difficult on occasion. Physical and emotional needs are being addressed, although monitoring is inconsistent in some cases. Some records are misleading and inaccurate. Residents are protected by the policies and procedures relating to the administration of medication, but more must be done to ensure complete records are kept and to provide staff with accurate information. There is progress in developing a qualified and trained staff team, although areas of resident specific training are yet to be addressed. Decisions to reduce staffing levels placed residents and staff in danger. Staffing levels must not be reduced below that dictated by the individual needs of the residents. 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. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. There is an informative statement of purpose and an accessible guide for prospective residents. There should be more information about the restricted accessibility of the ground floor kitchen and of the care arrangements of people who are considering using the service on a respite basis. The home is not consistently meeting the needs of one person using the service for respite care. There is insufficient information about the contractual obligations that the service has to each of the current residents. This means that the current residents cannot be assured that they are receiving a service in accordance with their stated needs and contract. EVIDENCE: There is an informative Statement of Purpose and Service Users Guide. The Service Users Guide was reviewed in October 2007 and has been revised. It now has better information about the fees and what elements of care and support they are for, in accordance with recent changes in legislation. The guide is produced in an ‘easy to read’ format, using plain English with photographs and pictures to make it more accessible to people who may find Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 10 ‘text only’ documents difficult to understand. The guides now also include the individual contract arrangements for each person moving into the service. The statement of purpose includes information about the premises and accessibility although it does not mention that ground floor kitchen facilities are not designed with people who use wheelchairs in mind. The ground floor is registered for people who use wheelchairs and this would be relevant information for people considering the suitability of the service. (See recommendation 1) There is little information about arrangements for the care of people who use the service on a respite basis. (See recommendation 2) There have been no new permanent admissions to the service since the last inspection. There are currently five people using the service on a respite basis. One of these people has complex personal care support needs, involving tube feeding, colostomy and urinary catheter care. This is unusual in a residential care setting. A training session had been given to a number of staff although few staff spoken with during the three days of this inspection are confident in delivering this type of personal care. This has, on occasions, led to failure to deliver appropriate personal care as planned. This means that the resident cannot be confident that his needs will be met whilst staying in this service. Staff who are confident have previous experience of working in nursing care environments. (See requirement 1) The annual quality assurance audit completed by the new home manager states that a comprehensive written assessment is undertaken before a resident is considered for placement within the home. Caretech have recruited a placements manager. The placements manager is involved in the process of identifying prospective residents for the service from referrals that Care tech receive centrally and working with the home manager during the assessment period. The assessment involves obtaining community care assessments of need and other information about individual parent support needs, along with visits and contact with the prospective resident and their family and/or current support team. Prospective residents have the opportunity to visit the home for meals or an overnight stay as part of their introduction to the service. This means they get an opportunity to experience life in the home before making a decision to move in. When a new person moves into the home there is a three-month trial period after which the suitability of the placement is reviewed Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 11 There is uncertainty as to the amount of one-to-one time that the service is contractually obliged to provide to each of the current residents. Some of the people currently using the service have support needs that are in excess of the staffing ratio of one staff to two residents described in the statement of purpose. This is the subject of a previous requirement that is still not met. (See requirement 2) Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Written plans for care have improved and are reviewed as often as required, although there are still gaps in the information recorded. Residents receive appropriate assistance to make decisions in their every day lives although more could be done to make day to day decision making and life planning more accessible to people. Risk assessments are detailed and have been reviewed recently. EVIDENCE: Each resident has two key workers who have responsibility for assisting the resident to plan their service. During the random inspection carried out in August 2007 it was noted that care plans had not been reviewed and revised when peoples care and support needs had changed. Care plan files contained a lot of out of date information and it was difficult too find current information. A requirement was made for improved care planning. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 13 The new manager has tried to focus her attention on getting the paper reviews up to date and there is evidence that care plans are now reviewed more often. The requirement is therefore met. The care plan is made up of a series of documents called individual support requirements. These identify how each of the residents are to be cared for and supported. There is information about people’s likes and dislikes. Support plans contain information about personal care and nutrition. The plans provide staff with information about how best to communicate with people and what they enjoy doing. There is also information about cultural and religious needs and how these needs are to be met. Current service goals are identified during placing authority or internal review. The information is detailed and comprehensive in some areas and lacking in others. For example, a resident who is unable to speak has a support plan highlighting emotional needs that include periods when she gets sad, shouts, screams and kicks out. There is a section of the form that asks how the resident wants to be treated by staff at these times. The section is blank, although staff were observed to know and interact well with the resident, to be observant of her mood and to respond accordingly. Some Care tech residents are assisting the provider in developing a more accessible and person centred system for planning care. This includes using computer software and photographs to make care planning documents more accessible to people with a learning disability. This will improve the accessibility of the plans. There are assessments of the risks relating to each persons needs, personal care and other support routines and of how these risks are to be minimised. The risk assessments examined are comprehensive and have been subject to regular review, although the quality of assessment and review is inconsistent. Most are detailed and provide staff with clear information on reducing risk but one did not make any sense, had been reviewed recently and was accompanied by a ‘read and sign’ document that had been signed by five members of staff. The document was removed on the second day of the inspection. Only senior staff are trained in risk assessment. An overall risk assessment audit tool is not available. This would assist key staff by giving them a list of areas to think about when considering risks to individuals. All staff should be involved in the risk assessment process so that they become confident in assessing and taking risks as part of helping people to develop and enjoy their lives. (See recommendations 3 & 4) Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 14 Some of the residents have an advocate. Advocates are involved in planning with and representing the views of individual residents in meetings, reviews and decision-making processes. Staff demonstrate an understanding of the role of the advocate and when they should be contacted. An advocate commented that the staff had been observed to be warm and caring and keen to keep residents safe. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is opportunity for people to take part in age, peer and culturally appropriate activities. Residents are part of the local community and they have opportunities to engage in leisure activities and to maintain their personal and family relationships. As all residents need support to access the community more must be done to ensure that there are an adequate number of staff on duty to support the activities planned for each resident. More must be done to ensure that their adequate food supplies in the home at all times. EVIDENCE: Current residents are supported to enjoy a range of activities either at home or out in the community. All need staff support to go out. Some attend day services, in which case home staff are required to take them and collect them at the end of the session. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 16 Activities supported by staff in the home include swimming, bowling, cinema, college, restaurants and daytrips. Residents have regular contact with their families and friends where possible. Those who attend church are supported to do so on a regular basis. In house activities include television and listening to music. The AQAA states that the service aims to improve the range of activities available in the home and in the community in the coming twelve months. The Commission previously recommended accurate recording of the amount of activity that residents participate in. Records indicate that staff try and maintain a log of activities and whether they are enjoyed. At the time of this inspection there is low occupancy in the home. This has led to a reduction in staffing. During this inspection some planned activities, such as taking residents to a music class in the community and a social club evening, could not be attended because of staff shortage. In addition, some residents have higher support needs and placing authorities have, in some cases, paid additional fees for one-to-one staffing. This is not reflected in the way that shifts are planned and staff are unaware of the additional time that is available to individual residents as part of their contracted service. (See requirement 2) Residents were observed to spend extended periods of time in the lounge in front of the television. Staff on duty throughout the inspection said that staff shortages are making it impossible to support the full range of community and in-house activities that each resident is scheduled to have. (See requirement 9) There is a house vehicle, suitable for people who use wheelchairs. At the time of this inspection it was noted that vehicle maintenance problems were preventing evening use of the vehicle. Each floor of the home has its own communal kitchen and staff prepare the meals. The kitchens are clean and hygienic although the first-floor kitchen is in need of refurbishment. It should also be noted that the ground floor kitchen facilities are not accessible to people who use wheelchairs so the home would not be suitable for anybody using a wheelchair who is independent in this area. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 17 The dining table in the ground floor dining room has been replaced. The new dining table is of a height that allows residents who use wheelchairs to sit at the table properly. A requirement made in this regard is therefore met. Food stocks were noted to be low during the first two days of the inspection. A menu plan was not in place and staff were observed to be making meals based on items available. (See requirement 3) Discussion with staff indicated that staffing shortage had been a problem with doing things like a main weekly shopping trip. On the third day of the inspection a large shopping trip was undertaken and food stocks, including fresh produce, were in adequate supply. Records are kept of the meals prepared for each resident. The records indicate that a range of nutritional and culturally appropriate meals are prepared, but the records have not always been maintained accurately. For example, the record for one resident contained an entry that when queried by the inspector, as the item would not have been an appropriate meal given the persons n. Residents are also supported to go to restaurants in the community. Staff said one resident particularly enjoyed this activity and were pleased to note that her appetite improved when eating out. Observation of a staff member supporting a resident during breakfast indicate that staff are following guidelines provided by a speech and language therapist to prevent one resident from choking whilst eating. The staff member sat with the resident throughout the meal and was observed to be patient and encouraging. Some of the residents have complex nutritional needs and swallowing difficulties. This means they are fed either entirely or additionally with Peg feeding tubes. This involves careful monitoring and recording. The records seen were incomplete or inaccurate. (See requirement 5) Feedback from a placing authority care manager indicates that there is a need for a wider range of activities, and a more pro-active and supportive role from staff to encourage residents to try new activities. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is good information about how each person is to be assisted with their personal care, but staff shortages and unfamiliar routines have made providing good personal care difficult recently. Physical and emotional needs are being addressed, although monitoring is inconsistent in some cases. Records are misleading and inaccurate. Residents are protected by the policies and procedures relating to the administration of medication, but more must be done to ensure complete records are kept and to provide staff with accurate information. EVIDENCE: There are individual support plans for how each person is to be assisted with personal care. These plans are sufficiently detailed and include information about how someones religion will affect their personal care arrangements. Residents were seen to be well dressed and groomed. One resident looked happy when staff discussed how well he gets on with a barber he has been visiting for many years (before he moved to the home). Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 19 There are also risk assessments relating to the moving and handling techniques involved in supporting each resident with personal care and bathing. At the time of the inspection staff on duty on the ground floor of the home said that recent staffing reductions had made it difficult to provide same gender personal care and staff were feeling rushed during the very busy early-morning period, making routine personal care, that involves two members of staff for each resident in most cases, very difficult. One person using the service on a respite basis has had particular problems in having his personal care needs met consistently. (See requirement 1) At the time the inspection there was no GP backup for any of the respite residents. People using the respite service do not live in Borough so their own GPs are some distance away. Some consideration should be given to what back up this provides to people with complex physical health needs currently being admitted. (See recommendation 5) Some of the residents also need support with physiotherapy exercises. Staff spoken with that they were confident about how these exercises were to be done but that time constraints mean that these activities were rushed or missed out altogether on some occasions. During the random inspection of the service carried out in August 2007 it was noted that records relating to one of the residents care were inaccurate or incomplete. Staff records of training indicated that not all staff were adequately trained to assist with gastric feeding An immediate requirement was issued to address this. During this inspection it is noted that staff have been trained to assist with gastric feeding, but records relating to fluid and food intake are still inaccurate. This element of the requirement is therefore not met. (See requirement 5) There is also extensive repetition in the recordings. For example, staff have four separate records to update for one resident on each shift. This may be contributing to the poor record keeping and should be rationalised. (See recommendation) There are good records relating to the health-care appointments that the residents attend. When a health professional visits the service, consultations and treatment are carried out in the privacy of bedrooms and visiting professionals complete their own records. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 20 Records for three people were examined. These indicated that staff sought medical advice as and when necessary. Feedback from a visiting health professional (nutritional nurse) during this inspection was positive and confirmed that staff in the home contact his team as and when necessary. Staff record how much each person weighs on a regular basis as part of their health monitoring. Records examined indicate that staff make necessary referrals and appointments should someone lose or gain weight unexpectedly. Feedback from a placing authority indicates that this area of monitoring is a concern in regards to the person they have placed in the home. The care manager had not been notified of a significant weight loss. Staff demonstrate an understanding of the process of making health treatment decisions in someones best interests if a resident is unable to understand or make a decision for themselves. This involves consultation with health professionals, care managers and advocacy. Health action plans are not fully developed. Medication is stored securely. Storage area temperatures are checked and recorded regularly and are within safe limits. Medication is supplied by a local pharmacy who provide printed medication administration records and supply prescribed medication in blister packs, where possible. The medication administration records that were in use at the time of this inspection were badly printed making it difficult for staff to make an entry on the correct date. Medication administration records should be checked for quality before they are introduced as the permanent record. (See recommendation 6) Medication protocols are in place for each resident within the medication administration record. Information about side effects and when to seek medical attention is also available. There were no apparent gaps in recording and a justified stock check of two prescribed medications proved accurate. There are no controlled drugs being stored or prescribed. At the time of the inspection all prescribed medications are in stock. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 21 A stock balance is maintained on a daily basis by the senior staff on duty. Some residents are unable to communicate verbally. As recommended in the random inspection report, there is information for staff on what they should look out for that would indicate that a resident is experiencing pain or discomfort. Staff spoken with said that they know the residents well and are able to assess whether they are in pain in most cases. One resident has been administered an analgesic for a considerable length of time. Staff said that they were unsure whether the resident is experiencing pain. The use of this analgesic should be reviewed with the doctor. (See recommendation 7) The records relating to the use of this painkiller lack clarity. Directions on the medication administration records say to take one or two tablets four times a day. There are records of four administrations each day but no record as to whether one or two tablets had been administered. Stock checks indicate that some staff had been have been administering one tablet and some staff had been administering two tablets. (See requirement 6) Guidelines are in place for the use of ‘As required’ medications that should only be administered in certain circumstances. Guidelines about a medication to be administered when one resident is having a bad seizure indicates that staff should contact the company on call system to authorise the administration. This may cause unnecessary and dangerous delay. These guidelines must be reviewed to ensure that staff have clear information about who makes a decision/authorises the administration of each of the ‘As required’ medications in use at the home. (See requirement 7) Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Many residents are unable to raise complaints themselves, and the majority of complaints are raised by other people on their behalf. These complaints have been investigated thoroughly. Residents are protected from abuse, neglect and self-harm, although more must be done to ensure that a record is kept of people visiting the home. EVIDENCE: There is a complaints policy and procedure. It is available in an accessible document to enable residents to better understand the process of making a complaint. The AQQA (Annual Quality Assurance Audit) indicates that there have been five complaints made in the last twelve months. All have been addressed within 28 days. Records relating to one of the complaints were examined. The record includes details of what was done by the home manager to investigate the complaint and includes copies of the letters sent to the complainants. A visitors guide is being introduced. This will provide information on how to raise concerns and give feed back to the service. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 23 Staff said that they would tell a senior staff member if they were unable to resolve a verbal complaint themselves or they would leave a message in the communications book. There is a complaints book for visitors in reception and the contact information for formal complaints is readily available and displayed. The staff team have attended training on Adult protection, this was provided by Lambeth adult protection manager. Staff have received in training in how to protect vulnerable adults from abuse and all spoken with had an understanding of whistle blowing. A visitor’s book is in place in the reception area and visiting professionals sign in when they arrive. A workman doing some construction on another building owned by the same provider visited the home several times during the inspection, but did not sign in. (See requirement 8) There was an adult protection investigation in August 2007, as a result of an anonymous complaint made to the Commission. The local authority investigated, along with the provider and the Commission. The main areas of the allegation were not proved, although the Commission issued immediate requirements in regards to record keeping and staff training. The registered provider also investigated and developed a series of actions for the home manager to work on as a result. The manager and staff spoken with showed a good understanding of adult protection procedures. All residents need assistance to manage their financial affairs and to safeguard their cash and valuables, which are held in safekeeping. Records are kept of cash balances and receipts obtained for purchases. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 & 30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well adapted, clean and comfortable. Communal space is restricted but there is an accessible rear garden. EVIDENCE: The home is divided into two units, the ground floor unit and a first floor unit. Entry to each unit is via key code. There are eight bedrooms on the ground floor, and five bedrooms on the second floor. Each unit has a kitchen and a lounge/diner. The ground floor is suitable for people with physical disabilities who use wheelchairs, with wide hallways, ceiling hoists to assist with transfers, and adapted bathrooms. There are an adequate number of bathrooms and toilets. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 25 There are standing hoists, standing frames and bath seats available. There is a passenger lift. There is a small level garden at the rear with direct access from the ground floor lounge. There is front of house parking for the house vehicle. The premises were clean and pleasant smelling throughout, although areas of the home are due for cyclical re-decoration. Bedrooms seen were well furnished and other than the bedroom used for respite, personalised. The home is close to transport links and high street shopping. The first floor kitchen has no windows and is too warm. New dining tables in the ground floor dining room are now of sufficient height for people who use wheelchairs to be seated comfortably. Communal space is limited. (See recommendation 8) This means that the service is not meeting minimum standards in terms of providing people on respite placement with separate premises including day space (one of the bedrooms is designated as for respite). Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is progress in developing a qualified and trained staff team, although areas of resident specific training are yet to be addressed. Decisions to reduce staffing levels placed residents and staff in danger. Staffing levels must not be reduced below that dictated by the individual needs of the residents. EVIDENCE: The home is staffed on a 24 hour basis. The stated staff ratio of the service is one support worker for two residents, however some of the current residents have higher care needs and have additional hours of care. As detailed elsewhere in the report, there were an insufficient number of staff on duty during this inspection. This meant that routine tasks such as personal care were being rushed or done without the correct numbers of staff. Physiotherapy, house food shopping, and leisure activities at home and in the community were either rushed, cancelled or were going ahead without a sufficient number of staff. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 27 This was raised with the registered manager and a senior Caretech manager and staffing numbers were increased immediately. A member of staff confirmed that the additional staffing now in place made it much easier. It is of great concern that this staffing reduction was introduced without consideration of the care plans and risk assesments in place for each resident. (See requirement 9) All staff are provided with a copy of their job description which details all areas of work. This work is monitored through supervision and appraisal. Staff attend team meetings on a monthly basis. Staff and residents are ethnically diverse, as is the local community. Staff within the home are of mixed ages and gender. There is a training matrix available and staff are contractually obliged to attend training sessions. Training records indicate that there is progress in ensuring that staff receive both mandatory and service specific training. Forthcoming training includes refresher courses in fire safety and epilepsy. The registered manager said that she contacts the company training team to arrange training sessions. Staff on duty throughout the inspection were observed to have warm, good humoured and friendly interactions with the residents. All of the professionals who commented said that they had observed caring staff who had worked in the service for a number of years. This provides residents with continuity. Several people commented that staff would benefit from training in communication. and one mentioned that they had overheard a member of staff referring to a resident as “Naughty”. This is unacceptable. There are 33 care staff. 14 have attained a vocational qualification in care (NVQ) at level 2 or above, and afurther 6 members of the care team are currently undertaking the award. (See requirement 10) A requirement is made elswhere in this report in regards to training staff to meet the specific needs of anyone admitted to the home, even on a temporary basis. (See requirement 1) No new staff have been employed in the service since the last key inspection. A requirement in regards to obtaining better recruitment records could not be Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 28 examined. It is carried forward to the next inspection and the standard has not been rated on this occasion. There are four tiers for supervision, and many supervisors. Not all have been trained in supervision. (See requirement 12) Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The new home manager has registered with the Commission and is qualified and experienced. The registered provider is doing more to assure that residents receive a quality service, although this is still at an early stage and must be developed. Systems are in place to keep residents safe in their home environment. EVIDENCE: The registered manager has experience in a similar care setting, an NVQ 4 and the Registered Managers Award (RMA). There are two deputy managers, one for each unit of the service. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 30 Feedback from care managers indicates that communication with the home was difficult during the period when the previous registered manager was on leave, and before the new manager was appointed. There is a new area manager, who visits the service each month in accordance with Regulation 26, to monitor the service on behalf of the registered provider. Copies of the outcomes of these visits are supplied to the registered manager and to the Commission. The reports produced are adequately detailed. There is a new quality assurance team in place and quality assurance systems are being developed. The home manager said that all stakeholders are being contacted to provide feedback about the service as part of this process. A full quality assurance assessment is due for completion in 2007. The outcomes of the quality assessment must be supplied to the Commission. (See requirement 13) There are a range of appropriate health and safety checks in place. This includes the regular checking of the home environment and professional testing of equipment in use at the home. COSHH materials are stored securely (substances hazardous to health, like cleaning and laundry products). Staff receive induction training in safe working practices and there is health and safety policy and procedure in place to provide guidance. Fire evacuation drills are carried out and the results recorded. A temporary electrical supply had been taken from the home to an adjoining property owned by the registered provider. The temporary supply was removed in the days following the inspection. The registered manager confirmed that an electrician visited and the supply is safe. The Commission awaits a copy of the certificate that confirms that the electrical wiring is safe. Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 1 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 2 X X 2 X Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 32 Yes Are there any outstanding requirements from the last inspection? Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 33 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 YA3 YA35 Regulation 18 Requirement The registered person must ensure that staff are adequately trained to meet the needs of any resident offered respite placement in the home. The registered person must ensure that the contract agreed and drawn up between the service user and the home specifies any additional one to one hours agreed with and paid for by the local authority. The timescales of 30/12/06 & 28/02/07 are not met. The registered person must ensure that there are adequate food supplies in the home at all times. The registered person must ensure that an accurate record is kept of the food intake of each resident. The registered person must ensure that: • The healthcare needs of any resident using a Peg feed are adequately monitored by suitably trained staff. This element of the requirement is met. • Records relating to fluid balance must be Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 34 Timescale for action 14/03/08 2. YA5 5 (1) a 14/03/08 3. YA17 12 14/03/08 4. YA17 17 14/03/08 5. YA19 12 17 14/03/08 maintained accurately and fluids must be given in accordance with planned care and specialist advice. IMMEDIATE REQUIREMENT issued on 29th August 2007 This element of the immediate requirement is not met. The registered person must ensure that medication administration records provide accurate information about the dose administered (where directions say to administer either one or two tablets). The registered person must review the guidelines in place that assist staff in making decisions about administering a medication that is prescribed to be used ‘As Required’. Guidelines must be clear and must not involve unnecessary or dangerous delays in administration. The registered persons must maintain an accurate record of visitors to the home. The registered person must, having regard for the size of the care home, the statement of purpose and the number and needs of the residents, ensure that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of the residents. The registered persons must ensure that staff attain a national vocational qualification in care at NVQ level 2 or above. A training plan for how this will be achieved must be supplied to DS0000055761.V347687.R02.S.doc 6. YA20 17 14/03/08 7. YA20 17 12 14/03/08 8. 9. YA23 YA33 17 18(1) 14/03/08 14/03/08 10 YA32 18 14/06/08 Chestnut Road Version 5.2 Page 35 the Commission by 11. YA34 19(4) a b The registered person must ensure that before a new member of staff is appointed all essential information is acquired, this to include a stamped professional reference, original certificates including proof of qualification. The registered person must ensure that staff are supervised by appropriately trained supervisors. The registered persons must supply the Commission with a copy of the quality assurance report when it is completed. The registered persons must ensure that the house vehicle, used by residents, is adequately maintained and safe to use at all times. 14/03/08 12. YA36 18 14/03/08 13. YA39 24 19/09/08 14 YA42 12 14/03/08 Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 36 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 YA1 Good Practice Recommendations The registered person should amend the statement of purpose and service users guide to state that the kitchen facilities on the ground floor are not fully accessible to people who use wheelchairs. The registered person should amend the statement the purpose of service users guide to include more information about arrangements for people who are considering using the service on a respite basis. The registered person should develop a risk audit tool that enables key staff to methodically assess risks posed to individual residents during activities of daily living. The registered person should involve all key staff in the process of risk assessment so that they become more confident in supporting residents to take risks as part of developing a more rewarding and independent lifestyle. The registered person should consider ways in which people using the respite service can have access to a local GP whilst they are staying in the home. The registered person should check pre-printed medication administration records before they are introduced as a permanent record to ensure that they are clear and accurate. The registered person should request a review of the regular administration of analgesics to one resident. The registered person should consider ways in which communal space can be increased. 2. YA1 3. 4. YA9 YA9 5. 6. YA19 YA20 7. 8. YA20 YA28 Chestnut Road DS0000055761.V347687.R02.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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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