CARE HOMES FOR OLDER PEOPLE
Chilterns End Greys Road Henley On Thames Oxfordshire RG9 1QR Lead Inspector
Marie Carvell Unannounced Inspection 10:45 11 & 12th June 2008
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chilterns End DS0000013154.V365295.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Chilterns End Address Greys Road Henley On Thames Oxfordshire RG9 1QR 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) 01491 574066 01491 574633 manager.chilternsend@osjctoxon.co.uk www.oxfordshire.gov.uk The Orders Of St John Care Trust Mrs Pauline Anne Krason Care Home 46 Category(ies) of Past or present alcohol dependence over 65 registration, with number years of age (3), Dementia - over 65 years of of places age (21), Learning disability over 65 years of age (3), Mental Disorder, excluding learning disability or dementia - over 65 years of age (1), Old age, not falling within any other category (46), Physical disability over 65 years of age (13) Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 46. 8th June 2007 Date of last inspection Brief Description of the Service: Chilterns End is a purpose built care home that was purchased by The Orders of St John Care Trust from Oxfordshire Social Services in the latter part of 2001. The home provides accommodation and care for a maximum of 46 older people over the age of 65, some of whom may be mentally or physically frail. The home also provides day care and respite short stays for a small number of people. The accommodation is provided in single rooms in a one-storey building. Chilterns End is set in its own grounds on the outskirts of Henley-on-Thames and is close to local health centres, shops and Townlands, the community hospital. The home has four units, each with its own kitchenette, dining and sitting rooms and there is also a large main dining room. Each unit has assisted toilets, bath and shower facilities. The building surrounds a central garden with a sensory area, planted with herbs and aromatic plants and a water feature. The garden and grounds have a range of garden seating and shaded areas, with easy access for residents from most areas of the home. The fees for this service range from £505.00 to £760.00 per week. Items not covered within the fees include hairdressing, podiatry, newspapers and magazines, toiletries and contributions to some outings and activities. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
This inspection of the service was an unannounced ‘Key Inspection’ carried out over two days. The inspector arrived at the service at 10:45 and was in the service until 19:15 on the first day and from 11:00 until 17:10 on the second day. It was a thorough look at how well the service is doing. It took into account detailed information provided by the Head of Care ( deputy manager) in the absence of the manager, in the form of the Annual Quality Assurance Assessment (AQAA) this is a self-assessment and summary of services questionaire that all registered services must submit to the Commission each year and any information that CSCI has received about the service since the last inspection. The inspectors asked the views of the people who use the service and other people seen during the inspection. No surveys were received from service users, health or social care professionals. Time was spent with one relative, who asked to speak to the inspector. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standards of the service. Time was spent with service users, staff on duty and the manager. A tour of the premises was carried out and a sample of records required to be kept in the home were examined, including case tracking of service user’s files and staff personnel records. In addition the inspector spent time observing how care was being delivered to service users and joined service users for lunch on each day. At the last inspection carried out in June 2007, three requirements and four good practice recommendations were made. The requirements were that service users’ assessments and care plans, containing sufficient information in order that their care needs are met appropriately, that the administration of topical medication is recorded accurately to ensure that service users are receiving them as prescribed and that staffing should be reviewed and amended to ensure that there is always sufficient staff available to meet the assessed needs of service users at all times. The good practice recommendations were that the home’s updated Statement of Purpose and Service Users Guide is available to prospective and current service users, that staff who administer medication have received appropriate credible training, improve the way in which service users choices and preferences about the way they spend their day and their interests and hobbies are assessed and Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 6 recorded. And that the results of quality assurance surveys are made available to current service users, prospective service users and other interested parties. These are referred to in the body of the report. Feedback was given to the manager during the two days and at the end of the inspection. What the service does well:
Service users and their representatives are given information about the home and are encouraged to visit in order to make an informed choice about moving in to the home. Several service users confirmed that they had visited and were able to stay for a trial period. This information is not necessarily recorded. All service users are admitted for a trial period of four to six weeks, before a decision is made to make Chilterns End their permanent home. In discussion with service users, several said that they had previously lived near the home or had stayed in the home for short stays in the past. One service user said that he/she was unsure if moving into the home was the right decision for him/her, but staff at the home had encouraged several short, day visits before making a decision. Service users were observed to be well groomed and appropriately dressed, attention had been given to ensuring service users had their spectacles, dentures, hearing aids and walking frames/sticks. From discussion with the manager and head of care, the inspector considers that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. Service users confirmed that routines in the home are flexible, such as being able to choose when to get up, when to go to bed and how they spend their day. Service users are able to bring their pets into the home and the home has two cats and two birds. The gardens are maintained to a high standard by the maintenance person and include an inner courtyard, which is secure and service users are able to make full use of and be involved with a number of garden projects. The housekeeping and maintenance team work hard and take pride in maintaining the home to a high standard. The home was fresh and free from unpleasant odours.
Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
The manager has given a verbal and written undertaking to address the following areas. Files of six service users were case tracked and although it was evident that some improvements had been made to the assessment and care planning process, care plans were still not in sufficient detail regarding lifestyle choices or the preferences of the service user with regard to when care is to be
Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 8 provided or how. No information is recorded in the care plan about how the emotional and social care needs of the service user or how these will be met. Appropriate behavioural guideline need to be in place to support staff, when dealing with service users with behaviours that challenge the service. The home has a ‘key worker’ system in place, described in the service user guide as ‘ the carer who will take a special interest in your care at this home’. None of the service users asked were able to name their key worker and in discussion with care staff about what the key worker role was described the role as ‘doing their shopping’. This was discussed with the manager, who agreed to address as a training need. The introduction of protected mealtimes was discussed with the manager, as the two care leaders were busy throughout the mealtime period administering medication, rather than being available to assist service users and monitor food intake. The manager agreed to consider this and discuss with the home’s GP. It is a recommendation of this report that the manager considers joining service users occasionally for a meal as part of her monitoring of food and mealtimes. Service users said that the food was variable depending on who was cooking and one service user said that he/she had requested some dishes to be put on the menu, this had not happened. The manager confirmed that currently verbal complaints are not recorded and agreed that in future all complaints whether received verbally or in writing will be recorded with action taken and outcomes recorded. Recruitment procedures need to be more robust. Five staff files were examined. In discussion with the manager about the recruitment process it was confirmed that some members of staff, complete an application at the time of their interview. The manager agreed to review this, as this is not considered to be good practice. Application forms did not ask for a full employment history, references were not requested from the prospective employers most recent employer. Some references were obtained from previous colleagues rather than employers and written ‘ To whom it may concern’ letters were accepted as references. Although it was evidence that prospective staff have an interview with the manager, the interviewers did not sign some documentation. A member of staff working as a care assistant, despite the application form and interview being for a housekeeping post. All staff are appointed subject to a six month probationary period. Evidence was seen of letters on file, confirming that staff have satisfactorily completed their probationary period, no information was recorded as to how the assessment was carried out. Since the inspection the manager has advised the Commission that a decision has been made to recommence the probationary period documentation and allocate a named buddy to each new member of staff. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 9 Staff meetings are held infrequently in the home. Staff meetings were held in June and December 2007 and two senior staff meetings held in January and February 2008. This was discussed with the manager and it is a recommendation that regular staff meetings are held, this is particularly important, due to the number of new staff recruited and for team building. Record keeping required for the protection of service users and for the efficient and effective running of the home are not maintained to a good standard, this is referred to throughout the report. Requirements made following the Commissions inspections to the home are not complied with within timescales given. None of the staff receive regular formal supervision. This was evidenced from examination of staff records and discussion with staff on duty. Staff meetings are held infrequently in the home. Staff meetings were held in June and December 2007 and two senior staff meetings held in January and February 2008. This was discussed with the manager and it is a recommendation that regular staff meetings are held, this is particularly important, due to the number of new staff recruited and for team building. The manager has recently returned to work following a period of sickness from early April until mid April and from April until June. The Commission were unaware of this until a phone call was received from a member of staff regarding the completion of the AQAA. The manager was reminded that it is a regulation that the Commission must be advised in writing if the manager is absent from the home, for whatever reason, for more than twenty eight days. 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. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Standard 1 was subject to a good practice recommendation at the last inspection. Standard 6 is not applicable, as the home does not provide intermediate care. Quality in this outcome area is good. Service users and their representatives are provided with information about the home, including a copy of the home’s Residents Guide. Service users are assessed prior to admission to ensure that their care needs can be effectively met by the home. All service users are able to move into the home for a trial period, before making a decision to stay permanently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 12 The Service User Guide and Statement of Purpose are reviewed regularly. A good practice recommendation was made at the last inspection that copies should be made available to prospective and current service users and other interested parties. This has been addressed. Oxfordshire Social Services have a block contract with the home for twenty six of the forty six beds. Service users and their representatives are given information about the home and are encouraged to visit in order to make an informed choice about moving in to the home. Several service users confirmed that they had visited and were able to stay for a trial period. This information is not necessarily recorded. Service user files of the last three service users to be admitted to the home were examined. All service users are assessed before moving into the home, information from health and social care professionals is requested as appropriate. All service users are admitted for a trial period of four to six weeks, before a decision is made to make Chilterns End their permanent home. In discussion with service users, several said that they had previously lived near the home or had stayed in the home for short stays in the past. One service user said that he/she was unsure if moving into the home was the right decision for him/her, but staff at the home had encouraged several short, day visits before making a decision. One relative of a service user recently admitted to the home for a trial period said that she was able to visit the home beforehand, as her father/mother was too frail. The relative was very pleased with the care and facilities available and said that her father/mother had improved both physically and mentally since being in the home. Staff were described as patient and kind. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. Standards 7 and 9 were subject to requirement at the last inspection and standard 9 was subject to a good practice recommendation. Quality in this outcome area is adequate. Care plans need to contain sufficient information to demonstrate that the needs of the service users are being met. Medication storage, administration and recording were seen to be well maintained. Service users feel that they are treated with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a requirement was made that service user care plans must contain sufficient information in order that all needs are met
Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 14 appropriately. Since the last inspection all care planning documentation has been reviewed and developed and care staff have received training in care planning. Files of six service users were case tracked and although it was evident that some improvements had been made to the assessment and care planning process, care plans were still not in sufficient detail regarding lifestyle choices or the preferences of the service user with regard to when care is to be provided or how. No information is recorded in the care plan about how the emotional and social care needs of the service user or how these will be met. The activity organiser records information about social activities and hobbies however, this information needs to be incorporated into the care plan. The manager and head of care accepted that there is a need to develop more person centred care plans. Following the inspection the Commission has received an action plan detailing action to be taken to develop further the care planning process. This included all care staff receiving additional care planning training and the manager has developed a document ‘ Care Plan Prompt’. The manager has since confirmed that staff feel much clearer about the process and have commenced reviewing care plans with the involvement of the service user and representative, as appropriate. The manager confirmed that all care plans will have been reviewed by the end of August 2008. Entries in daily records were varied in contents and should be in sufficient detail to validate the service users care plan. The manager agreed to address this as a training need. Service users were observed to be well groomed and appropriately dressed, attention had been given to ensuring service users had their spectacles, dentures, hearing aids and walking frames/sticks. The healthcare needs of the service users are met by a local GP practice and a range of healthcare professionals are available as necessary. From evidence seen and from discussion with service users and staff on duty, the physical health and medical needs of service users are being met. Information recorded on the AQAA stated that in May 2008 when the document was completed, seven service users had care needs associated with dementia and two service users had mental health care needs. Several service users have behaviours that challenge the service. No behavioural guidelines were in place or current involvement with appropriate healthcare professionals. One service user had a behaviour monitoring chart. Entries included ‘Left to sit in his/her room’ or ‘Left to calm down’. It was unclear if the action taken by care staff was taken following advice from a healthcare professional. The manager has confirmed that she has arranged with the home’s community psychiatric nurse to work alongside the head of care and care leaders to produce guidelines to form part of the care plan and advise on appropriate interventions to be undertaken by care staff. This must be written and reviewed on a regular basis. At the last inspection a requirement and good practice recommendation was made that medication administered is recorded accurately, staff that administer medication are appropriately trained, that handwritten changes to
Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 15 medication administration records should be witnessed and countersigned by a second carer and changes to service users medication should be cross referenced in daily records. These have been addressed. All staff who administer medication have received training from a community pharmacist, training meets the Skills for Care guidance. Currently there is no accredited training in medication administration for staff working in care homes. Therefore medication training must be provided by a credible source i.e. a community pharmacist. Medication storage, administration, recording and disposal were seen to be in good order. One of the care leaders has responsibility for all aspects of medication procedures in the home. None of the current service users administer their own medication. Risk assessments would be undertaken for any service user wishing to take responsibility for their own medication. The manager undertakes monthly medication audits in the home. Time was spent with service users in private or in groups. Service users were generally complimentary about the care provided. Comments made included ‘wonderful staff, but we don’t see much of the manager’, ‘ nothing is too much trouble’, ‘ some staff are better than others’, ‘ some of the staff are very caring, but others say they will come back in a minute, then forget’, ‘ some of them (service users) walk up and down at night and come into bedrooms uninvited’, ‘television is on all of the time, which is difficult as I wear a hearing aid, so can’t have a conversation with anyone’, ‘ very few residents able to hold a conversation with’, ‘ lots of new staff now’. None of the service users files seen contained detailed information regarding end of life care. The Trust is currently developing End of Life care plans and the manager and head of care have recently been on a training course. Staff were observed addressing service users by their preferred term of address and interacting with service users in a professional and respectful manner. The home has a ‘key worker’ system in place, described in the service user guide as ‘ the carer who will take a special interest in your care at this home’. None of the service users asked were able to name their key worker and in discussion with care staff about what the key worker role was, described the role as ‘doing their shopping’. This was discussed with the manager, who agreed to address as a training need. As in many other care homes, there is a wide range of racial, ethnic and faith backgrounds represented within the staff team compared with the current service users. From discussion with the manager and head of care, the inspector considers that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15. Standard 12 was subject to a good practice recommendation at the last inspection. Quality in this outcome area is good. There is a range of activities to meet the social needs of the service users. Service users are provided with a varied, wholesome and nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a good practice recommendation was made that consideration should be given to improving the way in which service users choices and preferences about how they spend their day and their interests and hobbies are assessed and recorded. This is currently being addressed as part of the care planning developments. There is a full time activity organiser in post. Information about weekly activities is displayed on notice boards in each of the units. Regular
Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 17 entertainment is provided. Activities include film shows, bingo, crosswords, board games, outside singers and entertainers, music and movement, cream teas and picnics. Several service users expressed their satisfaction of the gardens and being given the opportunity to ‘potter’. On the first day of the inspection a professional singer provided entertainment, during the afternoon. However, it was observed that in one sitting room, service users were left unattended, as the member of staff on duty for that unit, was occupied replacing items in service user bedrooms. Because care plans make no reference to service users preferred daily routine or their social interests or hobbies, it was not evidenced how individual needs are met for those service users, who prefer not to be part of a large group or are more suited to one to one attention. Several service users commented that hearing could be a problem in a large group. Many service users have friends or family who are able to visit on a regular basis. Service users are encouraged to maintain contact, as far as possible, with the local community. Religious ministers visit the home on a regular basis and arrangements can be made for service users to attend a local place of worship, if requested. Service user meetings take place; the activity organiser holds these. The manager attends some of the meetings. Service users confirmed that routines in the home are flexible, such as being able to choose when to get up, when to go to bed and how they spend their day. Service users are able to bring their pets into the home and the home has two cats and two birds. The inspector joined service users for the midday meal in two of the units. The days menu is displayed outside the dining room in each of the units and service users are offered a choice of main meals for the following day. On the first day, some service users said that they were never offered a choice of meal. The meal was placed before service users, with little or no verbal interaction, gravy was not offered, but was served with the quiche and the inspector, had to go over to one of the two the care assistants, to ask that one service user be given some assistance as he/she was having some difficulty. The manager said that she would address the concerns identified with the care staff involved. On the second day of the inspection, service users were joined for the midday meal in another unit, the two care assistants were chatting and assisting service users in an attentive, discreet and dignified manner. Service users were prompted as to the meal choice requested and given the opinion of changing their mind. Portions were appropriate and second helpings were offered. The introduction of protected mealtimes was discussed with the manager, as the two care leaders were busy throughout the mealtime period administering
Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 18 medication, rather than being available to assist service users and monitor food intake. The manager agreed to consider this and discuss with the home’s GP. It is a recommendation of this report that the manager considers joining service users occasionally for a meal as part of her monitoring of food and mealtimes. Service users said that the food was variable depending on who was cooking and one service user said that he/she had requested some dishes to be put on the menu, this had not happened. Bowls of fresh fruit are offered to service users at meal times, service users were observed to prefer grapes. Staff said that offering fresh fruit at mealtimes, although a good idea, didn’t work as fruit was being taken and left to rot in bedrooms or not eaten. It was suggested that maybe fruit could be peeled and offered to service users in the afternoons, as this seemed to work well in some homes. None of the current service users require a special diet. Menus seen demonstrated that a varied, wholesome and nutritious diet is provided to service users. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 19 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate. The home has a comprehensive complaints procedure in place and service users feel that their concerns are taken seriously and addressed. Policies and procedures are in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a comprehensive complaints procedure in place and is displayed in the entrance hall and each unit. The manager has confirmed that since the inspection the procedure has been updated to include the Commissions address. Since the last inspection the home has received three complaints, two complaints were upheld and the third related to events in the home some three years ago. The manager confirmed that currently verbal complaints are not recorded and agreed that in future all complaints whether received verbally or in writing will be recorded with action taken and outcomes recorded. Service users said that if they had a concern or complaint then they would speak to ‘someone in the office’, all felt confident that concerns would be taken seriously and addressed.
Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 20 Since the last inspection, the Commission has not received any information regarding complaints about this service. All staff receive training in the home’s policies and procedures for protecting service users from abuse and this was confirmed by staff on duty and training records. Training is provided during staff induction and then updated on a regular basis. Some staff were not familiar with the home’s whistle blowing policy. Information in the staff handbook about the procedure refers the reader to request details of the policy from the manager. This was discussed with the manager and since the inspection a copy of the whistle blowing policy has been displayed in the staff room and staff have been reminded to familiarise themselves with the procedure. No safeguarding adult referrals or safeguarding adult investigations have taken place since the last inspection. No referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. The home has a copy of the Oxfordshire safeguarding Adults procedures. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is good. The home and gardens are maintained to a high standard and provide safe and comfortable accommodation. The home is clean, hygienic and pleasant to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a purpose built building on one level. It is arranged in a E shape with four linked units providing smaller, more homely environments, each with its own sitting and dining areas. All areas are interlinked and this allows service users to move around the building safely and use the other communal
Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 22 spaces and the garden as they wish. The location and layout of the building is suitable for its stated purpose. Service users expressed their satisfaction of being able to personalise their bedrooms and the facilities within the home. All bedrooms are single occupancy and there are sufficient numbers of bathrooms and toilets throughout the home. Communal areas of the home have been made comfortable and the home has a welcoming and homely feel. There is an ongoing programme of redecoration and refurbishment in progress. The gardens are maintained to a high standard by the maintenance person and include an inner courtyard, which is secure and service users are able to make full use of and be involved with a number of garden projects. The housekeeping and maintenance team work hard and take pride in maintaining the home to a high standard. The home was fresh and free from unpleasant odours. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30. Standard 27 was subject to a requirement at the last inspection. Quality in this outcome area is adequate. Staffing levels appear to be adequate to meet the needs of the service users. Recruitment procedures need to be more robust. Training is promoted and staff are competent to do their job. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a requirement was made that a review of the numbers and skills mix should take place to ensure that there are always sufficient staff on duty to meet the assessed needs of service users at all times. This has been complied with. Since the last inspection there has been significant changes to the staff team with the head of care post vacant until August 2007, and resignation of the five care leaders, ten care assistants, three kitchen staff and three housekeeping staff. Most of these vacancies have now been filled and currently the home has vacancies for a part time night care assistant and 119.5 day care hours. Fifty two hours are due to an increase in care hours. The activity organiser now works full time in the care home. Several staff on long term sick leave are due to return to work soon. Discussion with the manager,
Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 24 head of care and staff on duty and examination of the duty roster demonstrated that generally there are six care assistants plus a care leader on duty during the morning, this is reduced in the afternoon to five care assistants and a care leader and on night duty there are two care assistants with a care leader sleeping in the home to provide on call cover. The shifts are 7am until 2.30pm, 2.30pm until 10pm and 10pm until 7am. Care leader work slight different shifts to include a hand over period. It is a recommendation and discussed with the manager that the duty roster demonstrates a handover for all care staff at the start of their shift. The manager and head of care feel that the staffing levels are adequate to meet the needs of the current service users and that usually, the night staffing levels are adequate. The manager said that frequently the care leader sleeping in the home is called for advice or assistance. It is a recommendation that a record is kept of all call outs. The manager has advised the inspector that following the inspection that additional staff may be able to be used in the situation were the needs of individual service users need additional resources at night. The home continues to use agency staff, to cover staff vacancies and the staff sick/annual leave. The care staff are supported by a team of administrative staff, catering, laundry and housekeeping staff. Four of the five care leaders have achieved or working towards National Vocational Qualifications (NVQ) at levels III/ IV. The majority of the thirty three care assistants/ bank care assistants are have completed NVQ training at level II or III or are working towards completion. Housekeeping, catering and the activity organiser have also undertaken appropriate NVQ training. The home has a training and staff development programme in place. All staff complete mandatory training and are encouraged to undertake ongoing training. Staff spoken to were positive about training opportunities available and felt that this gave them confidence in carrying out their duties and assisted with career advancement within the organisation. Recruitment procedures need to be more robust. Five staff files were examined. In discussion with the manager about the recruitment process it was confirmed that some members of staff, complete an application at the time of their interview. The manager agreed to review this, as this is not considered to be good practice. Application forms did not ask for a full employment history, references were not requested from the prospective employers most recent employer. Some references were obtained from previous colleagues rather than employers and written ‘ To whom it may concern’ letters were accepted as references. Although it was evidence that prospective staff have an interview with the manager, the interviewers did not sign some documentation. A member of staff working as a care assistant, despite the application form and interview being for a housekeeping post. Since the inspection the manager has advised the Commission in writing that recruitment procedures have been developed and now include the requirement
Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 25 to complete full employment history on the application form together with the names and addresses of two referees, one of which must be from the most recent employer. All staff commence duty following the completion of Criminal Record Bureau (CRB) application and checks being made against the Protection of Vulnerable Adults list (POVA). All staff are appointed subject to a six month probationary period. Evidence was seen of letters on file, confirming that staff have satisfactorily completed their probationary period, no information was recorded as to how the assessment was carried out. Since the inspection the manager has advised the Commission that a decision has been made to recommence the probationary period documentation and allocate a named buddy to each new member of staff. Staff meetings are held infrequently in the home. Staff meetings were held in June and December 2007 and two senior staff meetings held in January and February 2008. This was discussed with the manager and it is a recommendation that regular staff meetings are held, this is particularly important, due to the number of new staff recruited and for team building. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35 and 38. Standard 33 was subject to a good practice recommendation at the last inspection. Quality in this outcome area is adequate. An experienced administrator, head of care and a team of care leader support the manager. However, it is not evidenced that the home benefits from effective leadership and management. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is experienced and qualified, having completed NVQ IV and the Registered Managers Award. She has been the manager at Chilterns End since
Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 27 2005. The manager and head of care are both full time and are supernumery to the homes staffing levels. Service users told the inspector that they rarely saw the manager and usually spoke to the administrator about any questions or other staff ‘ in the office’. At the last inspection a good practice recommendation was made that the results of quality assurance surveys available to current and prospective service users should be made available. Quality assurance surveys are sent to service users each year. The manager confirmed that this is being actioned. Requirements made following the Commissions inspections to the home are not complied with within timescales given. Record keeping required for the protection of service users and for the efficient and effective running of the home are not maintained to a good standard, this is referred to throughout the report. Quality audits take place on a regular basis and include medication, health and safety, accidents/falls and care planning. Other than the manager auditing medication systems on a regular basis other quality audits are delegated to care leaders and the head of care. The manager said she was disappointed that documentation regarding service user care needed further development as she had delegated the role to a member of the senior staff. Procedures are in place for dealing with service users monies and valuables held in safekeeping by the home. None of the staff receive regular formal supervision. This was evidenced from examination of staff records and discussion with staff on duty. The manager confirmed that care leaders are to attend supervisory skills training and the home’s supervision documentations is to be simplified. All staff will then receive formal supervision and an annual appraisal in line with the Trusts policy. Policies and procedures are in place and reviewed on a regular basis. Reports written by a Cluster manager, who is also a registered manager of a OSJCT home, completes a written report each month on behalf of the provider, these were available for examination. From April 2008, the home’s Operations Manager also writes a report following a monthly visit to the home. Time was spent with the maintenance person and a sample of records relating to fire, health, safety and welfare were examined and seen to be maintained to a high standard. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 28 The manager has recently returned to work following a period of sickness from early April until mid April and from April until June. The Commission were unaware of this until a phone call was received from a member of staff regarding the completion of the AQAA. The manager was reminded that it is a requirement that the Commission must be advised in writing if the manager is absent from the home, for whatever reason, for more than twenty eight days. It was understood that this has already happened. Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x 2 3 Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No, please refer to the body of the report. 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chilterns End DS0000013154.V365295.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone 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
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