Inspection on 01/12/05 for Chiltern Cheshire Home

This inspection was carried out on 1st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chiltern Cheshire Home 08/05/07

Chiltern Cheshire Home 13/02/06

Chiltern Cheshire Home 23/11/04

Chiltern Cheshire Home 22/09/04

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

CARE HOME ADULTS 18-65 Chiltern Cheshire Home Packhorse Road Gerrards Cross Bucks SL9 8JT Lead Inspector Gill Gentles Unannounced Inspection 1st December 2005 14.15 Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 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 Chiltern Cheshire Home DS0000022961.V270988.R02.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 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. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Chiltern Cheshire Home Address Packhorse Road Gerrards Cross Bucks SL9 8JT 01753 480950 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) Leonard Cheshire Ms Hanne Abildgaard Care Home 22 Category(ies) of Physical disability (0), Physical disability over 65 registration, with number years of age (0) of places Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No persons over the age of 65 to be admitted. Date of last inspection 23rd November 2004 Brief Description of the Service: Chiltern Cheshire is a purpose built home set in Gerrards Cross. The home provides care for 22 adults who have a physical disability. Personal care and support is provided for both men and women between the ages of 18 and 65 yrs old. The home is situated in close proximity to the town centre where all local facilities can be found. Service Users utilise these services and the facilities of the nearby towns of High Wycombe, Slough and Uxbridge. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs Gill Gentles and Miss Sue Smith carried out this inspection unannounced on The 1st December 2005. The manager was present at the time of the inspection. The inspectors arrived at the home at 2:15 p.m. and left at 5 p.m. during this time a range of documents were viewed, residents were spoken with and a tour of the building took place. What the service does well: What has improved since the last inspection? Ensured that Risk Assessments are reviewed and updated appropriately. All overseas volunteers have Criminal Record Bureau Checks. Regulation 26 visits are carried out regularly and copies of the report are forwarded to the commission intermittently. Chiltern Cheshire Home DS0000022961.V270988.R02.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. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 7 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 Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Appropriate documentation is in place to ensure residents can make an informed choice about where they live. All prospective residents have individual assessments carried out to ensure the home can meet all their needs. Each resident have a written contract or statement of terms and conditions to ensure they receive the service they pay for. EVIDENCE: The newly registered manager has recently reviewed and updated the Statement of Purpose and Service Users Guide and has ensured that it is available to all current and prospective residents. Both documents comply with the National Minimum Standards, standard 1 and schedule 1. The home carries out a thorough assessment process. This takes place in the home for up to three months prior to a final decision being made by either party. Documentary records are clearly maintained ensuring that each individual’s needs can be met adequately. Each resident has received a comprehensive terms and conditions/contract which is signed by the resident or their representative and the manager of the home. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Clear and concise individual personal plans are in place, written by the resident to ensure individual’s needs are being met. Appropriate risk assessments are in place to ensure residents lead independent lifestyles. All documentation relating to individuals is handled appropriately ensuring residents know their confidences are maintained. EVIDENCE: Individual personal plans are clearly written by the residents themselves or in some cases by the key worker as dictated by the resident; this is clearly evident in the individual files. All plans include very detailed information such as:• A photograph, • Information relating to the individual • Guidelines for key workers • Complaints information • Essential information • Personal information e.g. i wish to be resuscitated Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 10 • • • • • Personal profile written by the individuals Medication consent form and information Personal care preferences Activity sheets and hobbies Outings. The information contained in these files was to a high standard, complete involvement of each individual was clear and the files read highlighted personal choice, participation and decision-making. Risk assessments were in place for each individual with a number due for reviewing within the next few weeks. All were found to be clear, concise and easy to read. All information relating to individual residents is stored in accordance with the home’s written policies and procedures and the Data Protection Act 1998. The majority of residents have chosen to keep their care plans in their individual bedrooms. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, Residents are supported and encouraged to have the opportunities for personal development, to take part in appropriate activities, to become part of the local community and engage in appropriate activities and relationships ensuring individual independence and choice is maintained. Residents are supported and encouraged to be involved in the daily routines of the home, promoting personal independence and growth. EVIDENCE: A number of resident’s access local colleges or are enrolled on distance learning courses or degrees via the computer. Individuals also access a variety of external daytime activities e.g. headway. Residents are free to come and go as they like ensuring that staff know when they have left the building, the home has approximately 80 volunteers who support residents to access leisure activities, maintaining individual’s hobbies and interests, for example one gentleman said he had been to Fulham several times to watch the football which is his passion. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 12 The home has a couple of part-time activity coordinators and an activity room in the basement that is due to be refurbished. Residents are encouraged to put personal ideas forward for activities they wish to take place and no pressure is put on anybody to attend the sessions. There is no restriction on visitors to the home; support is given to residents to maintain family links and friendships inside and outside of the home. Visitors are always welcome and encouraged to be involved in the daily routines. The home strives to promote independence, individual choice and as much freedom of movement as possible bearing in mind physical and emotional constraints. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, Residents are supported to take control and manage their own healthcare ensuring their physical and emotional needs are being met. The home has a medication policy and procedures in place, ensuring residents are safe from harm. EVIDENCE: Healthcare files were viewed and found to contain a vast amount of information, written by residents. All plans clearly identify the support needs of each individual in relation to their personal health. All residents have access to a GP, District Nurse and other medical professionals as and when required. A number of residents are supported and encouraged to retain, administer and control their own medication. There are risk assessments in place with clear procedural guidelines for each individual who self–medicates. Individual residents (where appropriate) have consented for the home to receive, record, store, administer and disposal of medicines on their behalf. In general medicines were found to be stored appropriately and in line with the guidelines issued by the Royal Pharmaceutical Society of Great Britain. However a couple of issues were noted. There were several gaps identified in the MAR sheets during the past few months and staff are still not putting date Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 14 of opening on creams and bottles especially if they have a limited lifespan once opened. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Clear written guidance and training is available to all staff in relation to complaints and abuse, ensuring residents are protected from harm. EVIDENCE: The home has policies in relation to complaints and Protection of Vulnerable Adults, which are reviewed and dated appropriately. The policies were found to be clear and concise and incorporated CSCI information. The majority of staff have received the relevant training, with the exception of two new employees who are awaiting training dates. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 The home is appropriately designed and located and generally well maintained so as to provide suitably equipped, decorated and furnished accommodation for the residents. EVIDENCE: The homes premises are suitable for its stated purpose, accessible to all, safe and well maintained to meet resident’s needs. The home is registered for 22 adults all with a single en-suite bedroom. Each room is fitted with the appropriate furnishings adaptations and equipment required by each individual. The premises appeared to be safe, comfortable, bright, clean and free from offensive odours. Heating and lighting is of a domestic nature, some residents spoken with commented that there were issues with the heating and hot water. This was discussed with the manager who confirmed that investigations were taking place. Each individual room includes furniture as identified in standard 26.2. Residents are encouraged to bring in their own furniture and personalise their own rooms. All bedrooms are lockable and each resident has their own key. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 17 There are adequate toilet and bathroom facilities throughout the home and all were found to be clean and tidy with the appropriate liquid soap and hand towels available. There are a range of comfortable, safe and fully accessible shared spaces in the three separate units. The premises were found to be clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection. Laundry facilities are on-site and residents are encouraged to do their own washing. The home has an appropriate clinical waste service in place with no over spilling of the bins noted, which are collected weekly. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 36 The home operates a recruitment procedure, that ensures all staff are appropriately vetted to ensure residents are safe from abuse Staff were generally well supported and enabled to deliver a good standard of care, however shortfalls were noted recently in the reduction of formal supervision. EVIDENCE: Four personnel records were viewed and found to contain the following information:• Application forms • Enhanced Criminal Record Bureau Checks • Terms and conditions • Interview records • Photographs • Date of birth • Date of commencement and other relevant information. Some concerns were expressed regarding overseas employees whose references are being translated by the home manager who herself is Danish. A strong recommendation was given to the manager for her well being, advising her to ensure authenticated translations are carried out. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 19 Staff supervision has deteriorated in recent months, it is acknowledged that due to a shortage of a senior team this area has been difficult to maintain. It is required that supervision for all staff recommences. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 Quality audits are carried out ensuring residents views are heard and taken on board to be developed by the home. Appropriate documentation in relation to health and safety checks and safe working practices are in place to protect residents from harm. EVIDENCE: A quality audit took place between the 10th and 14th of October 2005. Meetings were held with residents and key staff including volunteers. 21 resident questionnaires were giving out with 9 returned. The audit focused on key strengths, service provision, finance, health and safety and personnel. The findings have been forwarded to the home to develop an appropriate action plan. The home ensures that all appropriate health and safety checks are carried out as and when required:• Portable appliance testing is carried out annually in September, • Automatic doors are serviced in June and December, • The water boiler in April and October, Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 21 • • • • • • The lift quarterly Fire alarm service is carried out quarterly Emergency lights in April and September, Water testing quarterly Heating twice a year Hoists/baths twice a year also. The appropriate fire alarm testing and evacuations are carried out adequately and recorded appropriately. All COSHH data is accessible to all staff and is stored with the cleaning and maintenance equipment. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 3 X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Chiltern Cheshire Home Score X 3 3 x Standard No 37 38 39 40 41 42 43 Score X X 3 X X 3 X DS0000022961.V270988.R02.S.doc Version 5.0 Page 23 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement To ensure that there are no gaps on the Medication Administration Records and to date creams and lotions when opened. All staff must receive regular recorded formal supervision. Timescale for action 01/12/05 2 YA36 18(2) 01/01/06 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 34 Good Practice Recommendations That overseas references have authenticated translations. Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 Chiltern Cheshire Home DS0000022961.V270988.R02.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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