Inspection on 18/04/05 for Chiltern View (A)

This inspection was carried out on 18th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chiltern View (A) 12/12/07

Chiltern View (A) 21/02/07

Chiltern View (A) 27/11/04

Chiltern View (A) 14/05/04

Chiltern View (A) 22/08/02

Chiltern View (A) 19/03/78

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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 Chris Schwarz Announced 18th April 2005 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 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 Stationary 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) Version 1.10 Page 3 SERVICE INFORMATION Name of service Chiltern View (A) Address Oving Road, Whitchurch, Aylesbury, Bucks, HP22 4ER Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01296 641146 Milbury Care Services Limited Elizabeth Cypher Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Chiltern View (A) Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27 November 2004 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 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. Chlitern View has a cat, Thomas. Chiltern View (A) Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a weekday and lasted from 9.05 am to 4.45 pm. It involved discussion with the manager, meeting the home’s external line manager, speaking with staff and service users, a tour of the accommodation, examination of records and observation of the lunchtime meal. A preinspection questionnaire and comment cards were sent to the home prior to the inspection. What the service does well: What has improved since the last inspection? • • • • More staff have joined the team in order that agency use is reduced. This improves continuity of care for service users. Redecoration of the hallway and office have taken place to provide a more pleasant environment for service users. A sensory area has been created in the conservatory to provide stimulation and a quiet area for service users to make use of. Level access to the building has been achieved through improving the paved pathway, reducing the risk of service users injuring themselves. Chiltern View (A) Version 1.10 Page 6 • • • • • • • • Building security has been improved to prevent unauthorised people having access to service users. Confidentiality has improved through keeping the office locked when not in use. This ensures that service users’ personal details are kept safe. Policies and procedures have been updated to ensure that staff work in line with good practice to protect service users and promote their wellbeing. Arrangements for repair around the building have been improved in order that service users’ environment is made safe quicker. The home has its own carpet shampooer to keep carpets clean and odour free so that service users have a pleasant environment in which to live. A quality assurance audit has taken place by the provider to ensure that service users are being cared for to a satisfactory level. New patio furniture has been purchased so that service users have comfortable seats to use in good weather. Rotas clearly identify who is working so that it is easier to see who provided care to service users at any time. The majority of requirements have been met since the last inspection. What they could do better: • • • • • • • • • • • • Ensure that the female service user’s care plan states that she is only to receive personal care from female staff. Ensure that all service users have regular health checks, such as dental and optical. Ensure that drug administration records are accurately maintained – overdue from 2003. Provide abuse awareness training for service users – overdue from 2003. Ensure that recruitment is thorough. Ensure that staff training is undertaken for all required areas. Ensure that fire tests of the alarm always take place each week. Ensure that staff wear protective gloves appropriately. Ensure better co-ordination of mealtimes. Provide service user meetings/other forums in which to consult service users. Improve staff training records through producing individual training grids. Increase activities and ensure that records of activities show occasions when service users have been given a range of options but do not wish to take part. Chiltern View (A) Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chiltern View (A) Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Chiltern View (A) Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The admission process is well managed, ensuring that new service users have opportunity to make an informed choice about moving into the home. EVIDENCE: One person had been admitted to the home since the last inspection. There was evidence of pre-admission assessment to establish care needs and a series of visits had been undertaken for him to look at the home and meet people. A review had been arranged for six weeks after the date of admission. Chiltern View (A) Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 and 10. The home is generally effective in assessing and reviewing service users’ care needs to ensure that they receive the care they require. EVIDENCE: Care plans are in place for each person and show evidence of updating and regular review. Information was in place to meet complex care needs, such as management of epilepsy, and accompanying risk assessments describe any restrictions placed upon service users, primarily for their safety. Further work was needed to one care plan, as it did not specify that male staff were not to undertake any personal care for the female service user. A requirement is made to add this to the care plan. There has been a low level of communication support by the introduction of pictures to assist service users to make choices, such as with meals. There are no service user meetings at the home and these need to be developed over the coming year. A recommendation is therefore made. Improvement has been made to keeping care plan records secure through locking the office door when unattended. One person commented that the care at the home was “wonderful”. Chiltern View (A) Version 1.10 Page 11 Chiltern View (A) Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 and 17. Service users are involved in a range of activities and pastimes although more could be done to provide further variety and stimulation. Service users are enabled to keep in contact with family and friends, to help them maintain relationships. Mealtimes could be better managed to ensure that service users have co-ordinated meals. EVIDENCE: Improvements have been made at the home in recording the type of activities that service users have undertaken. However, more needs to be done to give service users activities throughout the week as records show that some people have done little other than stay at the home. Records could be improved to back up claims that some service users have refused a range of options on a number of occasions. A recommendation is made regarding the records of activities and a requirement is made to further increase activities for service users. One relative commented on the lack of activities for most service users. Chiltern View (A) Version 1.10 Page 13 There is limited day service attendance due to a lack of available spaces locally. An aromatherapist visits the home regularly as does a piano player; both coincided with the inspection and were clearly enjoyed by service users. Postal votes have been arranged where necessary for the forthcoming General Election. Daily reports and care plan documents showed that service users are enabled to keep in contact with family and friends. The home’s routines are flexible regarding times of meals and when service users get up and go to bed, as observed during the inspection. Menus show a variety of meals are provided at the home. Some relatives commented on food being of poor quality; on the day of the inspection service users had a reasonable lunch and food in stock was a mix of good quality and economy range products. Two service users said that they liked the food at the home and all enjoyed lunch. Management of lunchtime could have been handled better. One member of staff wore gloves to assist a service user to eat and it felt unco-ordinated with staff not knowing who was to be going out for lunch and who was staying in. A recommendation is made to improve mealtime management to ensure that these are pleasant and organised times. Chiltern View (A) Version 1.10 Page 14 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 standard(s) 18, 19 and 20. The home generally ensures that service users receive the medical support and assistance they need to keep them healthy, in partnership with outside agencies. The home is still not following good medication practice, which could put service users at risk from harm. EVIDENCE: Personal care guidelines are in place for each person at the home and all care was carried out in private. Care plan folders showed that most service users have been enabled to attend routine medical appointments although one person had not been to the optician since 2000 and the dentist since August 2002. A requirement is made to ensure that all service users have regular appointments for routine health checks. Service users also receive specialist treatments from Manor House Hospital. A medical professional commented, “The home is a happy place. The staff are also kind and helpful. They are sometimes under stress through pressure of work but interactions with the practice are appropriate and very satisfactory.” Medication was safely stored and administered by trained staff. There were some occasions whereby the final tablet on blister packs had been pushed through, ahead of time, without an explanation on the drug records. Drug Chiltern View (A) Version 1.10 Page 15 records need to reflect the reasons for this and a requirement is therefore made. Chiltern View (A) Version 1.10 Page 16 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 standard(s) 22 and 23. The home has an effective complaints procedure to ensure that service users’ concerns are listened to. Service users are not effectively being protected from abuse due to an untrained staff team and lack of awareness raising. This could put them at risk of harm. EVIDENCE: There is a complaints procedure in place. No complaints have been received during the period under review; a relative made a compliment. Chiltern View has a revised adult protection policy in place. Some staff need to attend training and awareness raising for service users has still not taken place, despite a requirement being made in 2003 and repeated subsequently. Chiltern View (A) Version 1.10 Page 17 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 standard(s) 24, 25, 26, 27, 28, 29 and 30 The environment at Chiltern View is attractive, with single, individualised bedrooms and pleasant communal areas. This means that service users have a homely and comfortable place in which to live. The rural location means that service users do not have easy access to shops and facilities; this has restricted their activities at times. EVIDENCE: Some improvements have been made to the home such as decoration of the hallway and creating a sensory area in the conservatory. The paved path leading from the car park to the home has been re-laid and is now an even surface. The provider has employed a person locally to maintain the home in a good state of repair; staff reported that this had improved the speed with which matters are attended to. There is now a carpet shampooer, which has improved the appearance of carpets and odour control. Building security has been improved through keeping side doors locked to prevent unauthorised access. The office has been painted and reorganised to Chiltern View (A) Version 1.10 Page 18 provide a more comfortable working environment. New patio furniture has been purchased for the home. All bedrooms at the home are single and have been decorated and arranged to different tastes and fulfil space requirements. The lounge/dining room can become over-crowded when all service users are around and this necessitates two meal sittings due to the amount of staff support needed. The home has the disability equipment it needs. All areas of the home were clean. The rural location means that all service users look out over fields from their bedrooms and the lounge. However, the location has restricted recruitment and a lack of staff has meant that sometimes activities have needed to be cancelled. Chiltern View (A) Version 1.10 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35. The home does not have robust recruitment practices, which could put service users at risk of abuse. Training is not up-to-date for all staff, which means that service users are not benefiting from a skilled and fully effective staff team and this could put them at risk from harm. EVIDENCE: Four new staff have commenced work at the home, transferring from other homes owned by the provider. Recruitment records revealed some undated references, some “to whom it may concern” references, absence of application forms in some instances and only one full Criminal Records Bureau certificate to refer to. A requirement is made to ensure that thorough vetting is undertaken for all staff working at the home and that it can be evidenced. This requirement is repeated from the last announced inspection. Training records showed that most staff had received up-to-date training in required areas, other than adult protection. A requirement is made for all staff training to be brought up-to-date, with refresher courses where applicable. As communication needs are significant at the home, training in this area also needs to be considered. A recommendation is made to produce a training grid for each staff file, in order that there is an at a glance guide to refer to. Chiltern View (A) Version 1.10 Page 20 Rotas have been improved since the last inspection and clearly show first and surnames of staff. Sufficient staff numbers are covering the home at the present time, according to rotas. Some of these are new staff who are undergoing induction. Feedback on comment cards referred to the home being short staffed with reliance upon agency staff but with service users being staff’s main concern and that they ensure needs are met. Another person said there was not enough trained staff. Mention was made by a couple of relatives of good staff leaving due to terms and conditions and the shift pattern, one person felt that an additional person should be on each shift to take service users out. Chiltern View (A) Version 1.10 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 40, 42 and 43. There is effective monitoring by the provider to ensure that the home is running effectively and that service users’ well-being is safeguarded. Health and safety is generally well managed at the home to protect service users from injury. EVIDENCE: Regular monitoring visits have been taking place at the home by a representative of the provider and all but two reports had been completed and sent to the home. A quality assurance audit has taken place, outlining good practice and areas to be strengthened. Polices and procedures have been updated. A range of health and safety checks is undertaken at the home. Fire safety checks are undertaken with regular drills, checks of emergency lighting and a Chiltern View (A) Version 1.10 Page 22 fire based risk assessment is in place. Weekly tests of the alarm system were not recorded for January this year. A requirement is set for weekly testing to be undertaken consistently. Inappropriate use of protective gloves was observed at lunchtime to assist a service user to eat and a second person was walking around the building wearing gloves, potentially spreading infection. Staff must be reminded of appropriate use of gloves and ensure that these are removed after leaving bathrooms and bedrooms. There was evidence of boiler servicing and hot water is routinely checked. The first aid box was well stocked and accidents are being recorded and monitored appropriately. Cleaning products are locked away. A draft business plan was in place. Insurance and registration certificates were displayed in the office. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 Chiltern View (A) Score x 3 x Standard No 22 23 Score 3 2 Version 1.10 Page 23 4 5 x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 2 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 3 x 2 3 Chiltern View (A) Version 1.10 Page 24 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 6 Regulation 13(6) Requirement The care plan for the female service user must specify that she is only to be assisted by female staff with her personal care. Staff must ensure that all service users have regular, routine health checks, such as dental and optical checks. Staff must maintain accurate records of drugs administered to service users. (Repeated from May 2004). Service users must receive input on abuse awareness. (Repeated from 2003). All staff must attend first time or refresher training on adult protection. Recruitment practice must follow rigorous checks, in line with schedule 2. (Repeated from May 2004). Staff must complete mandatory training or refresher updates, where applicable. Input on communciation should also be considered. Staff must be reminded of appropriate use of protective gloves and ensure that they Version 1.10 Timescale for action By 12 May 2005 2. 19 13(1)b From 12 April 2005 From 12 April 2005 By 01 August 2005 By 01 October 2005 From 12 April 2005 By 01 February 2006 From 12 April 2005 3. 20 13(2) 4. 5. 6. 23 23 34 13(6) 13(6) 19(1) 7. 35 18(1)c(1) 8. 42 13(3) Chiltern View (A) Page 25 9. 10. 11. 42 34 12 19(1) 19(1) 16(2)n remove these after leaving bedrooms and bathrooms. The full CRB certificate must be available for inspection. The full CRB certificate must be available for inspection. More activities must be offered to service users to give them variety and stimulation. From 12 April 2005 from 12 April 2005 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. 4. Refer to Good Practice Recommendations Standard From 12 Service user meetings or other consultation forums should April 20057 be established at the home. 12 Records of activities should include details of options refused by service users. 17 Mealtime management should be improved to make these occasions more co-ordinated. 35 Training grids should be produced for each staff file. Chiltern View (A) Version 1.10 Page 26 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close Aylesbury Bucks, 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 View (A) Version 1.10 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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