Inspection on 12/12/07 for Chiltern View (A)

This inspection was carried out on 12th December 2007.

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 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chiltern View (A) 21/02/07

Chiltern View (A) 18/04/05

Chiltern View (A) 27/11/04

Chiltern View (A) 14/05/04

Chiltern View (A) 22/08/02

Chiltern View (A) 19/03/78

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Chiltern View (A) Oving Road Whitchurch Aylesbury Bucks HP22 4ER Lead Inspector Maureen Richards Unannounced Inspection 12th December 2007 09:30 Chiltern View (A) DS0000022962.V353557.R01.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 Chiltern View (A) DS0000022962.V353557.R01.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. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chiltern View (A) Address Oving Road Whitchurch Aylesbury Bucks HP22 4ER 01296 641146 F/P 01296 641146 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) londonroad@tiscali.co.uk Milbury Care Services Ltd Elizabeth Cypher Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 2007 Brief Description of the Service: Chiltern View is registered to provide accommodation for up to ten adults with learning disabilities. The home is owned and staffed by Voyage formerly Milbury Care Services and is located in a rural location outside of the village of Whitchurch. The home is not on a bus route and is 15 to 20 minutes walk from a few local shops and pubs. The towns of Winslow and Aylesbury are a short drive away. All bedrooms at the home are single and accommodation is on the ground floor with level access throughout. Service users have a range of learning and physical disabilities. Chiltern View has a cat, Thomas. The fees range from £932.64 to £1229.54 Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for younger adults. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Comment cards were distributed to service users, relatives, visiting professionals and staff prior to the inspection. Replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of examination of some of the home’s required records, observation of practice, discussions with the deputy manager and staff on duty and a tour of the premises. Feedback on the inspection findings and areas needing improvement was given to the deputy manager during the inspection. Three requirements from the last inspection have not been complied with and this inspection has resulted in a further eight requirements. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. Feedback from a health professional was very positive and one comment include “Chiltern View is an excellent place which I am privileged to work with”. Feedback from relatives was positive with one relative stating that they have complete satisfaction in every aspect of their relatives’ care. What the service does well: Prospective service users are assessed prior to admission to ensure the home can meet their needs. Detailed care plans are in place, which ensures service users personal care and health needs are met. Profiles in care plans outline service users ethnic origin and any specific religious needs. Care plans include a range of risk assessments, which are up to date and reviewed. Some documentation has been developed in a user friendly format and as appropriate for individuals. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 6 Service users are supported to pursue their leisure interests and given opportunities to use community resources. Contact with family and friends is maintained to promote social links. Service users privacy and dignity is promoted and staff were observed to be respectful of service users. A nutritional well balanced meal is provided. Systems and procedures are in place to deal with complaints and to ensure the protection of service users from abuse. Permanent staff have the required mandatory training and other specialist training to support them in their roles. Safe recruitment practices are in place. Staff are approachable, knowledgeable and confident in their roles and they confirm that they feel supported in their role. What has improved since the last inspection? What they could do better: Profiles in care plans outline service users ethnic origin and any specific religious needs however this information was not easily accessible in the service users file to ensure that staff can support the individual with their specific need if they choose to. Where advocates are involved with individuals they should be invited to service user reviews. The manager should ensure that monthly service user one to one meetings take place and that the outcome of the meeting is recorded to evidence service user involvement and consultation in decisions. Moving and handling risk assessments must be reviewed on a regular basis to ensure the safety of service users and staff. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 7 Medication practices must improve and medication training must be provided to ensure the safety of service users. Adequate dining room space must be provided. Areas of the home are in need of decoration. The home must be kept maintained and a programme of redecoration and renewal must be put in place The Organisation must address the slow response to maintenance issues. The manager should monitor the hours worked by staff to ensure that staff are not working excessive hours, which potentially could put service users at risk. The manager should check to ensure that agency and relief staff have the required up to date mandatory training. Induction records should be set up for all new staff and signed off to confirm completion of induction. Filing within the home should be reorganised and made more accessible. Some improvements are required to health and safety practices. 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. Chiltern View (A) DS0000022962.V353557.R01.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 Chiltern View (A) DS0000022962.V353557.R01.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): 2 Quality in this outcome area is good. The home has an admission procedure in place, which should ensure that the home is able to meet individuals assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an admissions procedure in place which indicates that all prospective service users are assessed prior to admission, that visits take place and that the home liaises with other professionals and families prior to accepting someone for admission to ensure compatibility with the other service users. The home has had one admission since the last inspection who was subsequently discharged due to being considered unsuitable. The Organisation confirmed that the manager had carried out a full assessment of this individual prior to admission and had liaised closely with all professionals involved in the service users care. However after admission to the home behaviours were being displayed which were not identified from the assessment or from historical records for this individual. Staff at the home worked closely with a behavioural therapist in an attempt to manage behaviours but as the behaviours impacted on other service users the service user was given notice to leave and an alternative placement was found. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 10 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): 6,7,9 Quality in this outcome area is adequate. Detailed and specific care plans are in place, which adequately document service users’ needs and how these are to be met, moving and handling risk assessments need to be kept under review to support this and to promote the health and safety of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service user plans were viewed at this inspection. The files seen included a photograph, personal details, an outline of important people in their lives including photographs of family members, key health professionals involved in individuals care and reference to the individuals ethnic origin and religion. However one service users religion was not easily accessible in the service users file. Care plans outlined the person’s life story, likes and dislikes, positive things about the person, things they like and don’t like and things that are important to them. Service users plans outlined assistance required in the morning, evening and during the night with personal care, communication, day services, household Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 11 chores, mobility and with relationships and emotional needs. It included specific guidelines in relation to communication and behaviours displayed to enable staff to understand and meet the individuals daily needs. The files included specific care plans to meet the identified needs in relation to personal care, medical and social needs. All care plans showed evidence of a monthly review and care plans were updated to reflect change in need. The organisation is in the process of introducing a new care plan format and it is planned for those to be in place by the end of March 2008. The care plans indicate that service users are supported to make choices in relation to aspects of their daily lives for example meals, activities, getting up. Two service users have advocacy involvement. It is recommended that where advocates are involved that they are invited to service user reviews. The deputy manager confirmed that service users are welcome to attend the staff’s team meetings. A recommendation was made at the previous inspection that outcomes from individual meetings with service users are recorded in care plans and demonstrate how service users make informed decisions and how choices are made. Key workers meet with service users for a one to one meeting on a monthly basis but records seen indicate they are not taking place monthly. It is recommended that meetings take place regularly and that at this meeting service users are also given the opportunity to indicate if there are unhappy with any aspect of life at the home so that they can raise a complaint if necessary. Care plans seen include a range of risk assessments to manage identified risks Risk assessments are reviewed monthly. Care plans included moving and handling assessments, however some of those were implemented in June 2006 and showed no evidence of a recent review. This must be addressed. Service user plans included a missing person form with a photograph attached to be used in the event of a service user going missing. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 12 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 good. Service users are supported to have a varied, active and independent lifestyle which reflects their interests, provides them with nourishing meals and allows them to have contact with family, friends and the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the service users have a weekly activity plan, which is flexible and is dependant on their choice to participate. One service user attend a day service and this is being pursued for another service user. Some service users attend sensory sessions and others attend aromatherapy and foot massage sessions at the home facilitated by a qualified complementary therapist. Staff facilitate in house art and craft sessions and service users are given the opportunity to pursue their leisure interests with activities such as trips to the cinema, meals out, swimming and ice skating. During the inspection one service user went to the cinema, one went out for a drink and a small group of service users were going to the pantomime in the evening. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 13 Service users have the opportunity to go on an annual holiday with three small group holidays taking place over this year. Written and verbal feedback from staff indicates that there is limited staff employed to drive the minibus which limits activities and access to the community. The deputy manager confirmed that more staff are being trained to take on this role. Service user plans indicate that service users are supported to maintain contact with their families with regular liaison between the key workers and family members. Some service users go home for visits with support from staff as required and service users are supported to remember family birthdays and special occasions. During the inspection staff were busy preparing for Christmas and supporting service users to wrap Christmas presents for their family members. Completed comment cards from relatives indicate that they are kept up to date with important issues affecting their relative, service users are supported to live the life they choose and the home support service users to keep in touch with their relatives. Service users care plan outline individual routines and promote independence based on individual abilities. Risk assessments are in place to indicate why service users have restricted access to areas of the home and garden. Staff were observed knocking on service users door prior to entering and being respectful of the service users personal space and privacy. Staff were observed engaging with service users whilst supporting them with a specific task. Completed comment card from a health professional indicate that “staff are particularly attentive and treat service users with great respect, with their wishes being respected. Activities are planned bearing in mind each persons preferences” Service users have three meals a day with drinks and snacks being available and provided as required. Staff are responsible for cooking the meals. Service users are shown pictures to assist in their menu choices. The menu is planned on Sunday for the forthcoming week and a record of what is eaten daily by individuals is maintained. The menu is written in pencil and it is advised for this to be written in pen as it is one of the records required for Regulation. The menu seen was varied and service users were able to have an alternative choice if required. The lunch on the day of the inspection was balanced, nutritious, in appropriate portions and nicely presented. Service users are provided with appropriate eating aids and staff were observed assisting service users with their meals in a respectful way. A complaint was received by the Commission earlier this year that the food budget was insufficient, quantity of food was insufficient, and staff were not eating with the service users. The complaint was passed to the home to investigate. The Organisation requested Buckinghamshire Learning Disability Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 14 Service to undertake an investigation and they concluded that a satisfactory diet is being provided in sufficient quantities. Prior to this inspection feedback received indicate that sufficient fresh fruit was not being provided. On the day of the inspection fresh fruit was available in sufficient quantities. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 15 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): 18,19,20 Quality in this outcome area is adequate. The health and personal care needs of people living at the home are met however improvements are required to medication practices to further safeguard service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user plans outline the support required in meeting personal care needs. It outlines the morning and night time routine and the times for getting up and going to bed are flexible as was observed during the inspection. Service users have aids and equipment as required to promote independence and to promote their safety. Service users have access to specialist service services as required. The home can access the district nurses through the General Practitioner . All of the service users have a link and co worker and they work closely with service users in ensuring their needs are met in relation to health and personal care needs and in maintaining links with the families. Service user plans outline service users preferred routines, likes, dislikes and communication guidelines. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 16 All of the service users are registered at the local General Practitioner’s. Their care plans include a record of outcome of appointments with the General Practitioner, Dentist, Podiatrist and other specialists for example Physiotherapist, speech and language therapist and out patients appointments. Service user plans include weight charts but it was not clear on the frequency of weighing. This should be outlined in care plan. Completed comment card from a health professional indicate that the home is always attentive to minor changes in service users behaviours and other health related issues. None of the service users self medicate. Staff are responsible for the administration of medication. The medication file include a sample signature. The medication is stored in a locked cabinet situated in the office. The home uses a monitored dosage system and printed medication records with a photograph of each service user in front of their medication administration record. Records of drug administration were found to be in good order with no gaps evident alongside prescribed dose times. Discontinued medication was signed off by the manager but was not cross referenced in the General Practitioner health record. Staff should ensure that changes to medication are recorded in the service users file to ensure it can be tracked if required. The home has a record of disposal of medication back to the pharmacy. Cough sweets were stored in the medicine cupboard. The deputy manager confirmed that the home does not use any homely remedies and if homely remedies were required they would discuss with the General Practitioner prior to administration. The medication records indicate that some service users are given as required medication mainly pain relief but there was no individual guidelines in place on the administration of as required medication. This must be addressed. The deputy manager confirmed that new staff are inducted and assessed prior to being involved in the administration of medication. The completed assessment for one staff member was not available and the deputy managers assessment was completed but not signed off. Those records must be kept up to date, signed and available for inspection. The home has a number of service users who are prescribed and require rectal diazepam. A requirement was made at the previous inspection that the registered provider is required to ensure that training in the administration of rectal diazepam is approved by the local PCT and confirmation is sent to the Commission. The deputy manager confirmed that the PCT was unable to provide this training and an external training course have been accessed, however it was not clear from the certificate of attendance of training if staff were deemed competent to administer this medication. The deputy manager confirmed that he and the manager would assess staff for competency on administration of rectal diazepam as they are currently two of the staff who carry out this task. However the manager and deputy manager have not been signed off as Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 17 trainers in the administration of rectal diazepam. A further requirement has been made to address this. The home has a protocol in place for each service user on the administration of rectal diazepam which is signed off by the General Practitioner and authorises two named staff to administer the diazepam. At the time of the inspection the home had no controlled drugs but believed Diazepam to be controlled but the rectal Diazepam was not been treated as a controlled drug. Diazepam is a schedule 4 controlled drug which means that there are no special arrangements that are needed for care homes and it can be treated as an ordinary medicine. One service user plan seen indicate that his medication is administered with yogurt. This practice must be agreed and signed off by the General Practitioner and family. A requirement was made at the previous inspection that the registered provider is required to ensure that training in the administration of medicine is accredited for all care staff. The deputy manager confirmed that to date this training has not been accessed but that the Organisation is looking to provide this training next year. This requirement will be repeated at this inspection. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 18 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 good. Systems are in place to ensure service users views are listened to and acted on and to safeguard service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The competed pre inspection self assessment indicates that the home has had no complaints. The Commission had received two complaints in relation to this service, which were handed back to the manager of the home to deal with. The complaints log seen at the inspection indicate that those complaints were investigated and responded to appropriately. Service user plans include a pictorial copy of the complaints procedure and as outlined under standard 7 it is recommended that at the monthly keyworker sessions service users are also given the opportunity to indicate if there are unhappy with any aspect of life at the home so that they can raise a complaint if necessary. Completed comment cards from relatives indicate that they know how to make a complaint, one relative commented that usually concerns raised are addressed. Completed comment cards from staff indicate that they know how to support a service user to make a complaint. The competed pre inspection self assessment indicates that the home has had no safeguarding of vulnerable adults referrals in the past twelve months. The home has a safeguarding and whistle blowing policy in place and staff spoken with were clear of their responsibilities in reporting bad practice. The training records for five staff viewed confirm that they have attended safeguarding of vulnerable adults training. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 19 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): 24,30 Quality in this outcome area is adequate. The home is homely with bedrooms personalised, however adequate communal space is not provided, areas of the home are in need of decoration and response to maintenance issues must be improved to ensure that service users live in a well maintained, nicely decorated and safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chiltern view is located in a rural location on the outskirts of Whitchurch. The home is 15 to 20 minutes from local shops and public houses. The home has its own transport, which allows for easier access to Aylesbury and Winslow. It is a single storey building, which is accessible for service users with a physical disability. The home has a communal lounge /dining area, separate good sized kitchen, a separate laundry room, two bathrooms and a separate shower room. The home has adaptations such as grab rails and a hoist to support service users to maintain their independence. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 20 All bedrooms at the home are single. Four bedrooms were viewed at this inspection and found to be nicely furnished and personalised, with one bedroom adapted to meet specific needs to promote safety. The home has a conservatory which is used as a sensory room with various equipment provided. The home has one communal sitting and dining area, which is bright and homely but is not a sufficient size to meet the needs of ten service users, some of whom use specialist chairs. A requirement was made at the previous inspection that the registered provider is required to ensure that dining space meets the collective needs of service users in a safe and comfortable way and allows for meals to be taken in a congenial setting. An audit has been undertaken by the Organisation’s Health and Safety manager who confirms that the dining space is not sufficient to meet service users needs. Plans have been drawn up for an extension to address this. The deputy manager confirmed that he believes this work is to commence in February 2008. This requirement will be repeated at this inspection. A requirement was made at the previous inspection for the worktops in the kitchen to be replaced. This has been complied with. A requirement was made at the previous inspection for the damp in the shower room to be investigated and action taken to resolve. The deputy manager confirmed that this work had been done but the shower room still smelt of damp. This must be rectified. The hallway appeared in need of redecoration, in particular the woodwork and doors which were damaged by wheelchairs. Cracks were observed in the walls of one of the bathrooms. The deputy manager was not aware if the Organisation had a programme of refurbishment and redecoration in place and this is essential to ensure that the home is kept updated, decorated and maintained. The home has a record of maintenance requests which indicates a slow response to maintenance issues for example a report was made on the 24th September 2007 that the shower tray over the bath was too high and had no hand rails. This work was still outstanding at the time of the inspection. This must be addressed. Staff are responsible for the cleaning at the home and cleaning schedules are in place to support this. Some areas for example the woodwork appeared in need of a thorough clean and this should be monitored. The home has a separate laundry with sluicing facilities. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. Staff are appropriately trained and recruited to meet service users needs in a safe and consistent way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed to be accessible to and comfortable with service users and showed a good awareness of service users needs. The training records indicate that staff have some specialist training in epilepsy, autism, non violent crisis intervention and communication. The deputy manager confirmed that four staff have obtained a National Vocational Qualification. Feedback received from relatives commented that the home could improve by having better trained staff, in particular in autism. The rota indicate that there are at least five staff on day time shifts with a sixth member of staff on duty some occasions. There are two staff on the night time shift. The staffing section of the pre inspection assessment document was not completed. The deputy manager confirmed that the home has no full time staff vacancies and use relief and agency staff to ensure that shifts are covered. Staff spoken with confirm that they feel the staffing levels are Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 22 sufficient. However written feedback indicate that some staff felt that at times the staffing was not sufficient to meet service users needs and that when short staffed agency staff were not utilised. The rota indicate that some staff are working six days a week with three to four of those shifts being long days in succession. This should be monitored. Records indicate that regular team meetings take place. Five staff files were viewed. Files contained a completed proforma to confirm that two references and a Criminal Records Bureau check had been carried out. Some files contained a photograph and or copies of passports or driving licence and work visas and permits as required. The home has the required records for agency and relief staff. The deputy manager confirmed that new staff are inducted into the home and the newest staff member on duty confirmed this. However an induction workbook had not been commenced for this individual who commenced work on the 5th December 2007. This should be addressed. Training records seen indicate that permanent staff have up to date mandatory training. The training records for agency staff being used indicate that some mandatory training is overdue and this must be checked with the agency staff member and the agency. A completed comment card from a health professional indicate that staff are particularly dedicated, there has been few changes in personnel which has lead to a consistent level of stability and staff offer a very caring and personalised approach. Completed comment cards from staff confirm that the induction covers everything they need to know to do the job, that they have the required training to do the job, they get regular support from their manager and the staff work well together as a team. Some staff felt that the organisation should support staff to obtain an National Vocational Qualification. Some staff felt that the organisation should have a pay structure where staff are paid more for taking on more responsibilities for example shift leader. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 23 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): 37,39,41, 42 Quality in this outcome area is adequate. The home is generally well managed with systems in place to monitor the quality of care, however some health and safety practices in particular medication and response to repairs must improve to ensure the health and safety of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered manager was not on duty during the inspection. The inspection was facilitated by the deputy manager. The pre inspection assessment document confirms that the registered manager holds the City and Guilds Advanced Management in care and the Registered Managers Award level 4. She has seven years experience of management. Staff confirmed that they feel the home is well managed and that the manager is supportive and approachable. Staff appeared confident and comfortable during the inspection. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 24 Three requirements from the previous inspection have not been complied with and a number of requirements and recommendations of good practice have resulted from this inspection. The manager must ensure that these are addressed within the agreed timescale. The deputy manager confirmed that external monitoring of the home takes place and that Regulation 26 reports are completed. The records indicate that a report for May, August and November 2007 were not on file. The pre inspection assessment document indicates that an annual service review had taken place over the past 12 months, which seeks the views of families and other professionals. The deputy manager was unable to access a copy of the annual service review report for reference. It was observed that some records were difficult to access, contained old information and there appeared to be an excess of files in the office. The files should be reorganised and information made more accessible to ensure that the records required for Regulation are kept in good order. A sample of health and safety records were viewed. The home has a designated staff member who oversees health and safety. The home carries out a series of weekly and monthly health and safety checks, including water temperature checks, visual checks of equipment, fridge and freezer temperature checks, daily food temperature checks and first aid. There was some gaps in the recording of fridge and freezer temperatures. The home has records in place to confirm that fire exits, emergency lighting, fire extinguishers checks are carried out and fire drills take place on a regular basis. Last recorded fire drill took place on the 11th November 2007. The home has accident and incident records in place. The home has records in place to confirm that the fire equipment, fire alarm, boiler and hoists had been serviced. The completed pre inspection self assessment indicates that portable appliances tests have been carried out. During the tour of the environment it was noted that a number of appliances had an out of date service sticker on or no sticker to indicate if test had been carried out. This must be addressed. As outlined in standard 24 there is a slow response to maintenance issues which potentially could compromise service users health and safety. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 25 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 3 x 3 x 2 2 x Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 26 Yes 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 YA9 Regulation 13 Requirement Moving and handling risk assessments must be kept under review to ensure the safe handling of the service users. Medication assessments for staff should be available for inspection and signed off to confirm competency. Individual guidelines on the administration of as required medication must be put in place. The registered manager must ensure that staff who administer rectal diazepam are deemed competent to carry out this task by a person trained to make this assessment and that this assessment of competency is reviewed on a regular basis. The practice of administering medication with yogurt must be agreed and signed off by the General Practitioner and family. The registered provider is required to ensure that training in the administration of medicines is accredited for all care staff. (Previous timescale of 30/08/07 not met) DS0000022962.V353557.R01.S.doc Timescale for action 31/01/08 2 YA20 13 15/01/08 3 4 YA20 YA20 13 13 15/01/08 31/01/08 5 YA20 13 31/01/08 6 YA20 13 31/01/08 Chiltern View (A) Version 5.2 Page 27 7 YA28 23 8 YA24 23 9 YA24 23 10 YA42 23 The registered provider is required to ensure that dining space meets the collective needs of service users in a safe, comfortable and safe way, and allows for meals to be taken in a congenial setting. The registered provider is requested to send an action plan of how this will be achieved to the Commission. (Previous timescale of 30/05/07 not met) The Registered Provider is required to ensure that they investigate the possible cause for the damp in the shower room and then undertake any action to resolve this. (Previous timescale of 30/06/07 not met) The organisation must ensure that the home is kept maintained and decorated and that the slow response to maintenance issues is improved. The manager must ensure that up to date portable appliance testing takes place. 30/04/08 15/01/08 31/03/08 31/01/08 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 2 3 Refer to Standard YA6 YA7 YA7 Good Practice Recommendations Information on specific religious needs should be easily accessible in the service users file. Advocates should be invited to service users reviews where advocates are involved with individuals and family members aren’t. It is recommended that one to one service user meetings take place regularly and that at these meetings service users are given the opportunity to indicate if there are unhappy with any aspect of life at the home so that they DS0000022962.V353557.R01.S.doc Version 5.2 Page 28 Chiltern View (A) 4 5 6 7 8 9 10 YA14 YA17 YA20 YA33 YA35 YA35 YA41 can raise a complaint if necessary. It is recommended that Internet access is provided to the home. (Recommendation from the previous inspection) Menus should be written in ink. Staff should ensure that changes to medication are recorded in the service users file to ensure it can be tracked if required. The manager should monitor the shifts worked by staff. The manager should check that agency and relief staff have up to date mandatory training. Induction records should be set up for all new staff and signed off to confirm completion of induction. Files should be organised and information made more accessible. Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South East Regional Contact Team The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Chiltern View (A) DS0000022962.V353557.R01.S.doc Version 5.2 Page 30 - 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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