Inspection on 23/11/05 for Cheveley House

This inspection was carried out on 23rd November 2005.

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

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

Other inspections for this house

Cheveley House 05/05/06

Cheveley House 18/01/06

Cheveley House 14/09/04

Cheveley House 07/05/04

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE Cheveley House Cheveley Park Estate Belmont Durham DH1 2AD Lead Inspector Ms Kathy Bell Unannounced Inspection 23rd November 2005 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 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. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cheveley House Address Cheveley Park Estate Belmont Durham DH1 2AD 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) 0191 3863787 0191 3863787 Durham County Council Mrs Yvonne Gibbon Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (8) of places Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Named Individual The home may accommodate a named individual as set out in a letter to the registered person dated 25 October 2004 which establishes the basis on which the individual`s needs will be met by the home. Where necessary the home`s Statement of Purpose shall reflect any changes in service provision required for this arrangement. This condition may not apply to anyone else, other than the named individual, who falls outside the registered category. 14th September 2004 Date of last inspection Brief Description of the Service: Cheveley House is registered to provide care (but not nursing care) for up to 36 older people. It can also take up to eight people under 65 with physical disabilities into the intermediate care unit, providing the total number of people cared for in the home is not over 36. The intermediate care unit provides care for people who need to improve their mobility and ability to care for themselves before they can return home, after, for example, a stay in hospital. The home is near the centre of Belmont Village and has large grounds. It is built on two floors and all the bedrooms are singles. On the ground floor the home has a separate day centre in a large lounge, the intermediate care unit for eight people, and four bedrooms for people who receive respite care. The remaining 24 beds are on the first floor which has two lounge/dining areas with small kitchens and two more small lounges. The home has experienced a difficult couple of years. There have been a series of managers in post and recently there were not enough permanent staff and the home relied heavily on agency carers. A manager is now in post but has not yet applied to be registered with CSCI. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place during one day in November 2005. The manager was at the other home she oversees that day but the inspector was helped by the supervisors. The inspector, Kathy Bell, spoke with 17 residents, one relative, the two supervisors, three staff, and an occupational therapist who works with the intermediate care unit. Residents praised staff, describing them as very good, and kind and friendly. However residents commented that staff were very busy. They appreciated that staff were good about letting them know if they could not come and help them promptly because they were helping someone else . Two residents definitely thought that there were not always enough staff on duty. Staff felt they should be able to spend more time with residents. What the service does well: What has improved since the last inspection? A manager is now in post but needs to apply for registration with CSCI. She has been working to improve the appearance of the home for residents. Some redecoration has been carried out already. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 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 the following standard(s): 3&6 Although residents had been assessed before they were admitted to the intermediate care unit, this had not always prevented people being admitted who were not suitable. Although the unit has enabled many people to regain independence and return home, it does not have the same level of staffing provided in similar units. There was room for improvement in the way staff kept records and worked with people such as the occupational therapist. EVIDENCE: People who were to be admitted to the intermediate care unit had been assessed by the hospital and/or physiotherapists and occupational therapists. However the occupational therapist reported that they still sometimes received referrals for people who could not really benefit from the service offered. This is not the homes fault. They are continuing to work on improving local services understanding of what the unit can offer and who are appropriate people to refer to it. The standard rota provides two care staff on duty in the intermediate care unit throughout the waking day but on the day of inspection and the day before, Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 9 only one was on duty. On each day except Wednesdays, the care staff are responsible for domestic work on this unit. Staff reported that there are not particular staff who always work in this unit. Each week staff in the home, GPs, physiotherapists, occupational therapists meet and discuss the progress of each resident. In between times professionals write guidance in the daily recording for care staff to read and follow. Although the daily records seen described how each resident had spent the day, how much help, if any, they had received with personal care and how much they had been able to walk, they did not always record whether they had carried out the recommended exercises .In one case the occupational therapist had asked them to observe particular things and there was no sign that staff had done this. 35 of the 56 people who have used this service so far have been able to return to their own homes. Sometimes people have moved on to permanent care because that was their choice. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 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 Although each resident had a care plan containing information about the care they needed, most were not up-to-date and some did not include important information. Care plans are important because they contain the information which care workers must be able to rely on to know exactly how each person needs and wants to be cared for. The home appears to look after the health needs of residents and has generally satisfactory arrangements for looking after medication. EVIDENCE: Care plans seen contained out of date information, for example, on whether a resident was able to move about the home independently. The files for people in the intermediate care unit contained blank forms for moving and handling risk assessments. The daily records showed that sometimes staff restricted residents choices, for example, ensuring that a resident with confusion drank in moderation. This may well be justifiable, but care plans must show how risks have been assessed and give clear guidance to staff on what they can Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 11 and cannot do. Staff had referred residents who were at risk of developing pressure sores to the district nurse but had not completed formal written assessments to make sure they always picked up people at risk. There were clear records of when people had seen the doctor or other health professionals. These records showed that staff were active in obtaining health care for residents, calling doctors back out if they were not satisfied. Residents also felt that staff called the doctor out promptly and were sensitive in noticing if a resident was not well. Staff monitored whether residents were eating well or not and kept a check on their weight. Generally the arrangements for storing and recording medication is satisfactory but staff need to make sure that they are all recording the use of as required medication in the same way. This is important to avoid any uncertainty as to whether medication has been given, or offered to a resident. Residents who are capable of looking after their own medication, particularly those in for respite or intermediate care are able to continue doing this while they are in the home. All the staff who handle medication have received external training in this. Although staff had a copy of the Royal Pharmaceutical Society guidelines on handling medication they did not have a current medication procedure. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Residents are offered a choice of meals and generally enjoy the food provided. Staff are aware of individual needs and monitor whether residents are eating well or not. EVIDENCE: Residents generally felt that the food was good. Each day staff fill in a sheet which records what residents have chosen for their main meals. Staff also record whether each resident has eaten well or not. They told the inspector that if a resident starts to eat poorly regularly, they set up a full recording system to monitor more closely their food and drink intake. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 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 the following standard(s): None of these standards were assessed. EVIDENCE: Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 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 the following standard(s): 19 & 26 The home provides a comfortable and generally pleasant place to live, with the facilities needed to meet residents needs. Care is needed to make sure that residents safety is protected at all times and a satisfactory temperature is maintained. The home seemed generally clean but ongoing problems with the drains may have contributed to the smell of urine in one area. EVIDENCE: The home was purpose-built and has been upgraded to make sure it provides bathrooms adapted to meet residents needs. It has large grounds and a resident told the inspector of plans to develop them further. Residents bedrooms seemed pleasant and cosy and they had been able to fill them with their own possessions. Staff reported some problems in maintaining a satisfactory temperature as the heating system is not controlled from within the home. This had been made Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 15 worse on the day of the inspection because a number of toilet and bathroom windows had been left open in freezing temperatures. On the day of inspection a number of storage rooms were found to be unlocked. These included rooms containing chemicals and rooms which should be locked to minimise the risk of fire. The home appeared generally clean but there was a smell of urine in one corridor. It was not possible to be sure about the cause of this-staff described major problems with the drains to the building which could have contributed to this. The home has a sluice for laundry on each floor and a laundry downstairs. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 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 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 There are not enough staff on duty to meet residents needs and provide them with the attention they expect. EVIDENCE: The standard rota provides two care staff on duty in the intermediate care unit. They are also responsible for domestic work on that unit except for Wednesdays. However on the day of inspection there was only one care assistant working on this unit although the supervisors had tried to find someone to cover the shift. She was having to clean out a room which had been vacated so it would be available if needed. The rota provides another two care assistants and a supervisor on duty through the waking day for the rest of the residents, up to 24 on the first floor and four respite care on the ground floor. Domestic staff can help out when necessary, for example, by taking a resident to the toilet if a care assistant is not available. On the day of inspection a domestic was being used to supervise the respite care group as they ate their tea, because the three care assistants were each already deployed in three other dining areas and the supervisor was taking round the medicine trolley. While it is acceptable for domestics to help out in this way, as they have been provided with necessary training, care is needed to make sure that they have enough time for their own work. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 17 In addition to the hours on the rota, home care workers may spend time in the home when they are not required for domiciliary work. They fit in as needed but the home can never predict when they will be available. The NCSC (now CSCI) was advised that the Residential Forum guidance on staffing levels should only be applied to new registrations. However it provides a useful guideline figure for staffing, taking into account the dependency levels usually found in care homes now. Using the figures supplied by the manager on the number of residents considered high, medium or low dependency, these guideline figures would provide 4 care staff on duty for the residents on the first floor and the four respite care residents. Residents are clearly aware that staff are very busy and some told the inspector that they were not always enough staff. Staff feel they have not got enough time to spend with people and regret this. The failure to keep care plans up to date also indicates that staff need more time. It would be expected that the supervisors would take responsibility for making sure that records are up-to-date but with current staffing levels, they are needed to provide direct care for as much of the time as possible and do not have the time to review records. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 18 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 A new manager is in post but is not yet registered and is not able to devote all her time to the home. EVIDENCE: A new manager started work at the home last summer but has not yet applied for registration with CSCI. She is still spending some time overseeing a home she previously managed. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X X Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 6 Regulation 13 Requirement The manager must review how the staff record daily progress for residents in the intermediate care unit. Care plans must be kept up-todate and reviewed regularly. They must include all the information listed in Standard 3 of the National Minimum Standards. They must include explicit guidance if residents rights or choices are restricted. Staff must make sure they all record whether as required medication is administered or not the same way. Signatures on medication records must not be a single initial which could be mistaken for one of the codes which show, for example, medication refused. A comfortable temperature must be maintained in the building . Doors to rooms containing DS0000031184.V257126.R01.S.doc Timescale for action 31/12/05 2 7 15 31/01/06 3 9 13 01/12/05 4 5 19 19 23 13 23/11/05 23/11/05 Cheveley House Version 5.0 Page 21 hazards (hot water, chemicals, fire risks) must be kept locked. 6 7 26 27 23 18 Continuing efforts must be made 01/12/05 to control unpleasant smells. Care staffing levels must be 31/12/05 reviewed. The Registered Person must either provide for care staff on duty through the waking day, in addition to the two care staff in the intermediate care unit, or provide an explanation to CSCI of how they have calculated current staffing levels are satisfactory. The manager must apply for registration with CSCI. She must be full-time at Cheveley House. 31/12/05 8 31 8 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 9 Good Practice Recommendations A medication procedure should be provided. Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cheveley House DS0000031184.V257126.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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