CARE HOMES FOR OLDER PEOPLE
Cheverells Limers Lane Northam Bideford Devon EX39 2RG Lead Inspector
Dee McEvoy Announced Inspection 9th December 2005 10:00 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 Cheverells DS0000022173.V270691.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. Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cheverells Address Limers Lane Northam Bideford Devon EX39 2RG 01237 472783 NO FAX 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) Mr Philip Woods Mrs Gaynor Woods Care Home 36 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (36), Old age, of places not falling within any other category (36), Physical disability over 65 years of age (36) Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th May 2005 Brief Description of the Service: Cheverells Care Home provides 24-hour personal care for up to 36 men or women over the age of 65.The home is registered to care for residents with physical disabilities and mental health disorders. Cheverells is a large detached Victorian property with several purpose built extensions, situated just outside Bideford, with views across the River Torridge. The bedrooms are spacious, light and well appointed. The majority have en-suite facilities. Decoration and furnishings throughout the home are of a high standard. The home appeared clean and well cared for. Communal areas are also spacious and include three sitting rooms, dining room and a sun lounge. Externally the home is well maintained and sound. The garden is mature and beautifully kept; there is a pond with wild mallard ducks and a wooded area. An attractive chrome barrier surrounds the pond. The garden is accessible for residents to enjoy. The registered providers have commissioned an Occupational Therapist assessment of the home and have implemented many of the recommendations. A ramped entrance has been built to further increase access to the home. Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was the second of the current year and took six hours to complete. The pharmacist inspector accompanied the regulation inspector on this occasion. Standards met at the previous inspection (12/6/05) were not inspected during this visit. There were 33 residents living at Cheverells on the day of inspection and the inspector saw the majority of them; 6 residents were interviewed in depth and others were met in the communal sitting rooms and conservatory and in their private rooms. One relative was interviewed as well as four members of staff, and the owners Mr & Mrs Woods. A partial tour of the building was made, but not all residents’ rooms were seen on this occasion. A sample number of records were inspected which included, care plans, staff files, medication records/procedures, and maintenance records. A pre-inspection questionnaire had been completed by the providers prior to the inspection. What the service does well: What has improved since the last inspection?
Residents enjoy a well-maintained, homely and attractive environment, which meets their individual needs. Since the last inspection several bedrooms have been refurbished with new carpets. Carpets and chairs have also been replaced
Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 Page 6 in the sitting room and dining room, to maintain the high standard of the environment for residents. Raised beds have been planted in the beautiful gardens, which residents enjoyed greatly. The complaints procedure in the hallway has been amended to ensure that residents and visitors are aware of this procedure and whom to contact should they wish to raise concerns. 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. Cheverells DS0000022173.V270691.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 Cheverells DS0000022173.V270691.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): Standard 3 was met at the previous inspection. The home does not provide intermediate care. EVIDENCE: Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 Detailed care plans and staff knowledge ensure that residents’ health and personal care needs are met. However, there is a risk that staff will not meet needs if changes are not identified or planned for with regular reviews. Residents are encouraged to remain responsible for their medication where possible, however some areas of medicine handling in the home give rise to concern. EVIDENCE: Three care plans examined contained good detail and direction on how to meet residents’ needs, however not all had been reviewed regularly. Daily notes and accident records showed that one resident had fallen on occasions but the care plan had not been reviewed to reflect any changes needed to maintain the residents safety. Some good care planning was noted for one resident with diabetes. Secure storage is available for all residents to store their medication, however no risk assessments are carried out for these people and there is no record of the supply of medication to these residents. The date of receipt of medication and the quantity received into the care home is not recorded.
Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 Page 10 The medication is all stored in locked cupboards but at the time of the inspection the keys were not kept securely. This was addressed during the inspection. Hand written entries on the Medication Administration Record (MAR) charts are not signed and dated by the person making them and are not checked and signed by a second person. For medications prescribed with a variable dose it was not always possible to identify the dose actually administered from the records made. For external preparations there are not always records to indicate that they have been administered. Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 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): 15 The meals in the home are enjoyed and provide a varied wholesome diet for residents. EVIDENCE: The dining room is pleasant and homely. There was a lot of interaction between residents and staff at lunchtime and there was a buzz of conversation over meals. Most of the residents said they enjoyed the food and appreciated the choice of menus, comments included, “We have good home cooking” and “The food is excellent.” One resident felt that menus were a bit repetitive but accepted that alternatives were available. This was discussed with the providers who were keen to ensure that all residents were happy with the food provided. Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 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 & 18 The home has a satisfactory complaints system and residents’ feel their views are listened to and acted upon. EVIDENCE: The complaints procedure in the hallway has been amended, as recommended at the last inspection. None of the residents spoken with had any concerns or complaints, but all said they would be happy to talk to the owners or staff should they have any worries. Although care plans contained risk assessments when bedrails were used, consent for the use of bedrails had not been sought from residents. This is considered good practice and would eliminate any issues of restraint. Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 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): 26 Residents living at the home enjoy a clean and comfortable environment. EVIDENCE: Cheverells provides a clean, homely and attractive environment for residents. All areas of the home were clean, to a high standard, and smelt pleasant; one resident commented, “ It is always like this.” The laundry area is small but well organised. The laundry assistant was aware of the infection control policy and procedures relating to the handling laundry. Residents spoken with were happy with the laundry service; saying that their clothes were well cared for, one said, “The laundry service is marvellous.” Where residents have infections, good care planning was noted to reduce cross infection and the necessary protection gloves and aprons were available. Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 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): 28 & 29 Residents benefit from having skilled, experienced and friendly staff who have a good understanding of their needs. The recruitment practices of the home have the potential to allow the employment of members of staff with the potential to place service users at risk. EVIDENCE: A well-trained and experienced staff team support the residents. Residents confirmed that their needs were understood and met by the staff, comments included, “I am well taken care of here” and “They are all very sweet and helpful”. One relative said, “People come first here. The staff are very caring.” The home is well on the way to achieving the expected minimum number of staff with NVQ 2 or above. All staff working at the home only commence employment after the receipt of a satisfactory CRB and POVA check into the home. The application form used by the home does not obtain a previous employment history, and there is no evidence to demonstrate that this is explored. Some staff have commenced working at the home before written references have been either received or requested. Where references have been obtained there is no evidence that the authenticity of these has been checked. There are copies of staff contracts, including terms and conditions that have been signed by the individual members of staff available in the home. Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 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, 33, 35 & 38 The home is well managed, and residents’ benefit from influencing the way the home is run. The health and safety of residents is in the main being promoted. EVIDENCE: The providers have owned the home for nearly twenty years and are very experienced in working with older people. One of the providers has successfully completed the Registered Managers Award. Residents and staff expressed their complete confidence in the providers, comments from residents included, “Nothing is too much trouble for Mr & Mrs Woods” and “They spoil us!” The home operates an annual cycle of quality assurance to ensure that residents influence the way in which the home is run and that standards are maintained. CSCI does not currently receive reports on any review of quality of care.
Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 Page 16 Residents or their relatives/representatives manage personal finances; the home is not involved with residents’ monies. The cook on the day of the inspection had not received food hygiene training and appeared unfamiliar with some basic aspects of good practice, for example fridge temperatures and food storage. It was accepted that this person only cooks on one day of the week, when the regular cook is off duty. Fire safety is well managed at the home; records showed that staff receive regular fire safety training and fire equipment is regularly serviced and maintained. Maintenance certificates were inspected for equipment such as stair-lifts and found to be satisfactory. Electrical and gas safety certificates were up to date. Comprehensive risk assessments are available to maintain safe working practices. Several radiators around the home are not covered and do not have low temperature surfaces; risk assessments had not been completed. Accidents are recorded but not in line with Data protection. Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 1 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 3 17 X 18 2 X X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 Page 18 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 09/02/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This refers to the need to record the receipt of all medication received into the care home. Also the need to have a record of the supply of medicine to those Service Users looking after any of their own medication. Also the need to have a record of application of medicines used externally. Also the need to restrict access to medication to those members of staff authorised to administer medicines. Also the need to ensure that it is possible to determine from the records made the dose administered to the service user. Requirement Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 Page 19 2. OP29 19 (1) (a)(b) (c) The registered person shall not employ a person to work at the care home unless he/she has obtained in respect of that person information and documents specified in paragraphs 1 to 7 of Schedule 2. This refers to the need to ensure that 2 written references relating to each member of staff working in the home are available and that the authenticity of these references has been verified. The registered person shall ensure that the persons employed to work at the home receive training appropriate to the work they are to perform. This refers to basic food hygiene training for staff undertaking the preparation and cooking of food. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; This refers to uncovered radiators around the home. 09/02/06 3. OP38 18 (1) (c) (i) 09/02/06 4. OP38 13 (4) (a) 20/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that reviews are monthly, include residents (or their representatives) where possible, and reflect changing needs. Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 Page 20 2. OP9 It is recommended that when an entry is hand written onto the Medicines Administration Record chart that this is signed and dated by the person making the entry and it is then checked and countersigned by a second person. It is recommended that the risk assessments for all service users looking after any part of their own medication be reviewed. It is recommended that all staff trained to administer medicines have their competence reviewed as part of the supervision process at least twice a year. It is recommended that consent is obtained from residents or their representatives where bed rails are used. It is recommended that a copy of quality assurance reviews/evaluations is sent to the Commission, and be made available to residents and their representatives. It is recommended that all accidents be recorded in line with Data protection. 3. OP9 4. OP9 5. 6. 7. OP18 OP33 OP38 Cheverells DS0000022173.V270691.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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