Inspection on 14/11/07 for Chilworth House

This inspection was carried out on 14th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Chilworth House 01/02/10

Chilworth House 18/11/09

Chilworth House 20/01/09

Chilworth House 20/05/08

Chilworth House 15/11/06

Chilworth House 19/12/05

Chilworth House 04/08/05

Chilworth House 13/01/05

Chilworth House 02/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Chilworth House 7 Rectory Avenue High Wycombe Bucks HP13 6HN Lead Inspector Suzanne Magnier Unannounced Inspection 14th November 2007 07:30 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 Chilworth House DS0000022964.V354363.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. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chilworth House Address 7 Rectory Avenue High Wycombe Bucks HP13 6HN 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) 01494 526867 01494 526140 simon@lloydscott-healthcare.co.uk Lloyd Scott Healthcare Limited vacant Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2006 Brief Description of the Service: Chilworth House is a care home providing personal care and accommodation for 28 older people. It is privately owned. The home is situated in High Wycombe and is a short drive away from the amenities that a large town can offer. The home has been owned and operated by Lloyd Scott Healthcare since 1998 and has undergone many improvements since then. It is a well-maintained Edwardian building and the improvements are in keeping with the style of the building. There are 26 single bedrooms and two double rooms, which are comfortably furnished. The home has two lounges and a pleasant conservatory. There is a sheltered outside sitting area and well-kept garden. The fees for the home range from £360.00 for a shared room to £650.00 for a single room. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. Some additional standards were assessed and have been included within the report. Ms S Magnier Regulation Inspector carried out the inspection and the acting manager represented the service. For the purpose of the report the individuals using the service are referred to as residents. The inspector arrived at the service at 07.30 and was in the home for ten hours. It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The inspector spent time talking with residents and visitors in order to seek their views about the home and the care services provided. No questionnaires from the Commission had been sent out as the inspection was rescheduled due to some concerns received by the commission. 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 standard of the service. Documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, the terms and conditions of residency in the home, care plans, daily records and risk assessments, medication procedures, staff files, a variety of training records, health and safety records, and several of the services policies and procedures. Following the previous key inspection in November 2006 four requirements were made which involved improving staff recruitment procedures to safeguard residents, staff training with regard to safeguarding procedures and fire prevention and safety in the home. A random inspection was conducted in May 2007 in response to complaints received by the commission as to the standards of care in the home. During the inspection it was noted that none of the four requirements previously made at the November 2006 had been met. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. What the service does well: Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 6 The staff team have continued to provide consistent care to residents despite the lack of clarity regarding the management of the home. Residents spoken with during the inspection were generally satisfied with the quality of care and support provided by staff. Visitors spoke highly of the staff team and the efforts they make to ensure the residents are happy and content. What has improved since the last inspection? What they could do better: A total of twenty-one requirements have been made as a result of this key inspection and can be viewed in detail at the end of this report. The home’s Statement of Purpose and Service User Guide must be updated. Copies must be made available to prospective individuals and residents living in the home. Copies of both amended documents must be sent to CSCI local office. It is recommended that the Statement of Purpose and Service User Guide are made available to individuals with diverse needs for example sensory impairment and developed to large print or available in audio cassette in order that all individuals would have access to information in a format suitable to their needs. All residents must be fully informed of their terms and conditions of stay in the home, the fees and method of payment of fees. All prospective residents must have a care needs assessment prior to admission to the home in order to ensure that the home could meet the individual’s needs. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 7 All residents must have a documented care plan, which is agreed by the resident or their representative and kept under review in order to meet the needs and promote the welfare and wellbeing of residents. It is recommended that the home continue to introduce a person centred approach to care planning that would benefit the residents receiving care and support at the home. The home must request a local authorities review regarding any resident’s care and ongoing suitability of placement in order to promote and make proper provision for the health and welfare of residents. The home must review the current risk assessments to ensure that all the hazards in residents daily lives are clearly documented, measures are in place to ensure their safety and well being and reviews are undertaken at appropriate times. Professional advice must be sought about the promotion of resident’s continence and acted upon and the current supply of aids reviewed for individual residents in order to ensure their needs are fully met. Robust arrangements must be made for staff training, recording, handling, safekeeping, safe administration and disposal of medicines received into the home. Suitable arrangements must be made to ensure that the home is conducted in a manner, which promotes the residents rights to dignity and respect at all times. The home must inform the Commission for Social Care Inspection (CSCI) of the ongoing catering arrangements of the home to ensure that properly prepared meals are available to residents and the home is appropriately staffed. The home must ensure that suitable arrangements are made for the disposal of kitchen waste and food must be stored in compliance with food safety regulations in order to protect residents from hazards to their health and well being. The homes complaint procedure must be updated and include the local CSCI office details. A complaints log must be completed to detail a clear chronology of events for example dates of correspondence and outcomes regarding complaints received by the home and an update of outstanding complaints must be sent to the CSCI local area office. An immediate requirement was made that the home must review their policy and procedures regarding safeguarding vulnerable adults to reflect compliance Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 8 with the local authorities multi agency policies and procedures in order to safeguard people in their care. The proprietor and acting manager must ensure that all staff are trained in adult protection. Timescales from previous inspections not met 31/03/07 & 31/05/07. Failure to comply with this regulation is an offence and may lead to enforcement action. The heating in the conservatory area must be restored in order that residents have adequate heating to ensure their welfare and wellbeing. The staffing numbers must be reconsidered and the duty rota revised to include more effective deployment of staff in order that residents needs are met at all times. The proprietor must ensure that copies of the information required by Regulation 19, Schedules 2 and 4 of the Care Homes Regulations 2001 (as amended 2006) are in every staff member’s file. Timescales from previous inspections not met 31/03/07 & 31/05/07. Failure to comply with this regulation is an offence and may lead to enforcement action. The home must ensure that persons employed by the registered person to work in the care home receive training appropriate to the work they perform including a structured induction to ensure that the homes staff are suitably trained and competent in their duties. It has been recommended that the home devise a matrix plan of training, which is easily accessible to determine the shortfalls and audit refresher training for staff. The proprietor must inform the CSCI in writing of the ongoing management arrangements of the home in order to ensure the effective management of the home and the safety and wellbeing of residents. Please contact the provider for advice of actions taken in response to this Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 9 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. Chilworth House DS0000022964.V354363.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 Chilworth House DS0000022964.V354363.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): 1, 2, 3, 6. Quality in this outcome area is poor. This judgement has been made using a range of evidence including a visit to this service. Prospective residents and their representatives do not have accurate information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures do not ensure that individual’s needs are appropriately identified and met. Terms and conditions/contracts of stay at the home are not available to all individuals. The home does not provide intermediate care. EVIDENCE: The inspector sampled the homes Statement of Purpose (dated 2005) and Service User Guide. The documents were not accurate in informing prospective residents or their representatives about the services provided by the home for example the current management arrangements of the home as the documents refer to the previous manager, the numbers of staff employed in the home are not accurate and have been reduced, the complaints procedure Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 12 refers to the previous manager as being the complaints manager and the commission details are incorrect. It is required that the Statement of Purpose and Service User Guide must detail the information required in respect of the Care Homes Regulations 2001 Schedule 1 (as amended September 2006). The Statement of Purpose and Service User Guide is not currently available to individuals with diverse needs for example sensory impairment and developed to large print or available in audio cassette in order that all individuals would have access to information in a format suitable to their needs. It is recommended that this be considered when updating the documents. The Statement of Purpose contained a blank copy of the terms and conditions of a residents stay in the home. Whilst sampling two residents files no information could be located within the files to evidence that the resident had been fully informed of their rights of residency and cost of services provided by the home. It is required that all residents be fully informed of their terms and conditions of stay in the home, the fees and method of payment of fees. The acting manager explained that she or the responsible individual undertakes the documented pre admission assessment for prospective residents and the information gathered forms the initial care plan for the individual. The inspector sampled two resident’s files of individuals newly admitted to the home. Only one file contained a documented pre admission assessment regarding the needs and support required by the individual. The acting manager acknowledged that this was a significant shortfall and a requirement was made that all prospective residents must have a care needs assessment prior to admission to the home in order to ensure that the home could meet the individual’s needs. Chilworth House DS0000022964.V354363.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): 7, 8, 9, 10. Quality in this outcome area is poor. This judgement has been made using a range of evidence including a visit to this service. The health and personal care that residents receive is not based on their individual needs set out in their care plans for some individuals. Monitoring of risk assessments is not robustly maintained to ensure the safety of residents in the home. Medication procedures do not ensure that medication is administered to all individuals in a safe and appropriate way. Resident’s dignity and respect is not consistently promoted. EVIDENCE: The inspector sampled two residents care plans which illiustrated the differing care needs and how care and support were provided. The care plans were well documented to reflect residents individualised personal care needs and how the resident prefers personal care to be delivered, the condition of residents skin/pressure areas, sleep patterns, accident and falls records/audit, nutrition and diet, mobility, daily records of care provided and activities undertaken throughout the day, the residents likes and dislikes, sensory awareness, religion, next of kin, a clothing inventory and missing persons identity chart. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 14 Whilst the plans were in place it has been recommended that the format of the care plans be reviewed and expanded, for example, using one care need with identified goals and assessment with evidence of reviews having taken place at least once a month in order to ensure that the current needs of the resident are met. As previously documented one resident newly admitted to the home had not had a pre admission assessment and the acting manager advised that the resident did not have a care plan. The acting manager recognised this significant shortfall and an immediate requirement was made that all residents must have a documented care plan, which is agreed by the resident or their representative and kept under review in order for the home to meet the needs and promote the welfare and wellbeing of residents. The care plans daily records were generally recorded and signed by the acting manager and not by the staff member providing the care. This was discussed with the acting manager who stated that several staff would probably forget to complete the records following providing care to a resident. It was noted that the home had commenced to introduce a person centred approach to care planning and this was discussed with the acting manager as good practice in order to reflect more details about the residents identity, personality and communication, social interest, past occupation, their lifestyle history, hobbies and likes and dislikes as it was recognised that the care plans were essentially task based. The manager acknowledged this improvement and recommendation that would benefit the residents receiving care and support at the home. One care plan evidenced that the resident had enduring specific needs, which the acting manager explained staff supported on a daily basis. The person’s choice of lifestyle tested the home and other residents and their refusal to receive personal care was also challenging. The acting manager advised that the resident did not have a care manager and that the suitability of their residency in the home had been brought to the attention of the proprietor. Whilst meeting with residents it was noted that another resident required support by two staff using a portable hoist. The staff explained that the resident spends a lot of time in their room and is only supported downstairs for special events, as the hoist does not fit easily into the homes shaft lift. This issue was discussed with the acting manager and it has been required that the home must request a local authorities review regarding any resident’s care and ongoing suitability of placement in order to promote and make proper provision for the health and welfare of residents. Whilst sampling the care plans the inspector observed that the plans included statements which detailed the actions in place to minimise the risk to the resident for example falls and walking unaided. Some statements did not contain the authors name, date of writing or review and there was no evidence to support that the resident had been consulted about the statement. There Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 15 was also no evidence in the care plans to demonstrate that the hazards identified had been further developed to include a full risk assessment in order to ensure the safety and well being of the resident. This process was discussed with the acting manager and a requirement has been made that a full review of the current risk assessments be undertaken to ensure that all the hazards in residents daily lives are clearly documented, measures are in place to ensure their safety and well being and reviews are undertaken at appropriate times. Whilst touring the premises the inspector noted that it was the practice of the home to put the name of the resident on their bedroom door and names on the doors of the bathrooms and toilet. Some resident’s room doors and bathrooms and toilets did not have names on and this was brought to the acting managers attention who advised that this matter would be dealt with in order to assist residents to identify their surroundings. The care plans included records of health care appointments that residents had attended and also visits of specialised health care professionals to the home. The health care professionals included the general practitioners, chiropodists and opticians. During the inspection the family of one resident supported them to attend an out patient appointment at a local hospital. The home supports residents with management of personal care including management of continence. The inspector enquired about the arrangements of supporting residents with continence management and was advised that several residents require additional aids. The acting manager advised that three incontinence pads are available to each resident over a twenty-four hour period, which would include one pad being used during the night. The inspector was informed that in the past a continence management advisor had visited the home and it has been required that professional advice be sought about the promotion of continence and acted upon and the current supply of aids reviewed for individual residents in order to ensure their needs are fully met. The inspector requested to sample the homes medication policy and procedure and noted that the document was on a top shelf in the office situated in the dining area of the home. It was noted that the policy was dated January 2007 and was in draft form. Staff appeared to be unfamiliar with the policy and procedures for example the policy contained a staff signature sheet and medicine temperature charts which were blank and when questioned staff advised that they were not aware that the documents were available. The inspector sampled the medication cupboard in the home, which was stored in one of the offices in the home. The cupboard was orderly, clean and was well stocked. The home has a monitored dosage system (MDS), which is supplied by the local Pharmacist. The acting manager explained that a senior Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 16 care worker has overall responsibility for the ordering, returns and stock taking of medicines in the home. The acting manager advised that some residents prefer to self medicate and they are supported to maintain their independence and choice. The inspector sampled guidelines regarding residents self-administering creams and inhalers to ensure that people were safely taking their medication. It was recognised during the inspection that the home supported resident’s rights not to take their medication and the acting manager reassured the inspector that ongoing refusal to take medicines would be alerted to health care professionals. The acting manager advised that three staff were trained to administer medicines. From a random sampling of training records the inspector noted that one designated staff members file did not contain evidence that they had undertaken medication training. The inspector sampled some current and archived medication sheets, which were generally accurately completed by staff administering medication. The inspector noted that on occasion staff had not signed for medication administered, some staff initials had been defaced and on one occasion one resident had not received medication for a week in June 2007 due to the home not completing the ordering and stock taking of medicines in the home accurately. The medication file was disorderly and contained some photographs of residents and not of others and some medication sheets were loose in the file. A requirement has been made that robust arrangements must be made for staff training, recording, handling, safekeeping, safe administration and disposal of medicines received into the home. During the inspection one of the homes GP’s arrived to undertake a review of some residents medication. The inspector was advised that the home is not currently supporting any residents with the administration of controlled medicines. During the inspection it was noted that there was a calm atmosphere throughout the home. In general it was observed that staff addressed residents in a professional and caring manner and residents were addressed by their first or full name and where appropriate names of endearment were used to support trusting relationships. Staff were observed to preserve and maintain residents dignity and privacy by knocking on their room doors prior to entry and supporting resident’s discreetly to the bathroom. The inspector observed on two occasions that resident’s rights to dignity and respect were not recognised. Staff were observed to support one resident in a shared bedroom with their meal at lunchtime and suppertime with the other resident sitting next to a used commode without a lid. A staff member advised the inspector that another staff member had pushed the commode into the room whilst they were supporting the resident whilst the other member of staff appeared oblivious to commode until the indignity was addressed by the Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 17 inspector. The incidents were brought to the acting managers attention and also that of additional observations of other residents sitting in their rooms at meal times with commodes without lids on. Staff spoken with during the inspection told the inspector how they support residents yet there was little evidence to support that staff used residents care plans as a working document. This observation was reinforced by the inspector observing that documented guidance and directions regarding the care of residents and the use of wheelchairs had been fixed to items of furniture in resident’s rooms and in communal areas in the home. A requirement has been made that suitable arrangements must be made to ensure that the home is conducted in a manner, which promotes the residents rights to dignity and respect at all times. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 18 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): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using a range of evidence including a visit to this service. Residents are able to exercise choice in the daily lives, maintain bonds with family and friends, and take part in social, cultural, religious and recreational activities. The home provides a healthy and balanced diet in a pleasant spacious dining area however clarification of catering arrangements must be sent to the Commission. EVIDENCE: The inspector spent time talking with residents and visitors to the home and comments about the care provided at the home was favourable. Several residents told the inspector that they like to stay in their rooms and would join in the homes activities when they wished. One resident told the inspector that staff respect their lifestyle and that they had learnt a lot about other countries from the multi cultural staff team. It was noted that residents were moving freely around the home, several residents were observed reading the daily papers and chatting with other people in the home including staff. Volunteers to a local day centre had supported one resident whilst other residents stayed at home. Some residents Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 19 told the inspector about their hobbies for example reading, sewing and listening to the radio and advised that they are able to do this at the home. Several resident told the inspector that they enjoyed the private entertainers that visit the home. The home has an attractive and well-maintained garden, which residents said they enjoyed in the summer months. The home promotes peoples spiritual and religious beliefs by providing church services within the home. The inspector observed that there were visitors in the home who appeared at ease with the staff and were able to visit their relatives and friends in privacy. Several residents told the inspector that they have visitors to the home with one resident stating ‘I wouldn’t be here if it wasn’t good, my family thinks its alright’. The dining area was well presented with clean tablecloths, appropriate crockery, cutlery, napkins and condiments. Sauces/relishes were available upon request. Several groups of residents were observed sitting and chatting together. The inspector observed the serving of breakfasts, the midday meal and evening meal. The midday meal consisted of a hot meat dinner with vegetables and gravy whilst the evening meal was a ham salad with chips. It was noted that choice was available and some residents were supported with a soft diet and vegetarian meals were also available. Residents spoken with generally enjoyed the meals provided by the home and it was observed that staff were available to support people during the mealtime. The inspector did not sample the homes menus at the time of the inspection. The arrangements regarding the meal preparations were discussed with the acting manager as the inspector had observed that throughout the day care staff were employed to prepare meals for the home in the absence of the homes chef who was on holiday. The acting manager advised that the home is waiting for Criminal Records Bureaux (CRB) clearance for a weekend chef yet she had had difficulties obtaining information regarding an update to the process as the proprietor was overseas and the financial controller to the home had advised the home that they and the proprietor were the only persons permitted to seek clarification from the bureaux regarding the status of the process of obtaining the CRB disclosure. During the evening it was observed that the staff member undertaking the meal preparation was the senior care staff who was in charge of the shift. The inspector questioned how the senior carer could oversee the shift and supervise junior staff whilst being in the kitchen undertaking meal preparation. It has been required that the home inform the Commission for Social Care Inspection (CSCI) of the ongoing catering arrangements of the home to ensure that the home is appropriately staffed. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 20 Whilst touring the kitchen the inspector observed that the waste bin in the kitchen did not have a lid and opened sauces/relishes bottles and blocks of cheese stored in the fridge had not been labelled in compliance with food safety and hygiene standards. A requirement has been made that the home must ensure that suitable arrangements are made for the disposal of kitchen waste and food must be stored in compliance with food safety regulations in order to protect residents from hazards to their health and well being. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 21 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): 16, 18. Quality in this outcome area is poor. This judgement has been made using a range of evidence including a visit to this service. The homes complaints procedure is not an accurate document for individuals to express any concerns or complaints. Residents are not protected from abuse by the homes policies and procedures and not all staff have received appropriate safeguarding adults training. EVIDENCE: The home has a complaints procedure dated January 2006. The complaints procedure refers to the previous manager being the complaints manager. The complaints procedure details that the home will acknowledge complaints within two days and investigation into written complaints are held within twenty eight days and all complaints will be responded to in writing by the home. The Commission has received several complaints regarding the home and during the inspection the inspector sampled the homes complaints logbook and noted that no complaints had been documented as having been received by the home. The inspector sought to clarify the current status of the complaints received by the home and was advised by the acting manager that the proprietor had been dealing with the complaints and she was unaware if they had been resolved as she was not party to the information. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 22 A requirement has been made that the homes complaint procedure must be updated and include the local CSCI details. A complaints log must be completed to detail a clear chronology of events for example dates of correspondence and outcomes regarding complaints received by the home and an update of outstanding complaints must be sent to the CSCI local area office. The inspector sampled that the home has the local authorities multi agency procedures for safeguarding adults dated 2004. These were not readily available in the home and it was advised that the policies be more readily accessible to staff. The homes policy statement regarding reporting abuse was noted to be in conflict with the local authorities multi agency procedures for example that staff are advised to report sexual abuse to social services but report all other abuse to the proprietor or ‘care manager’ (manager of the home). The staff advised that any allegation of abuse would be written down and given to the proprietor ‘to deal with’. An immediate requirement was made that the home must review their policy and procedures regarding safeguarding vulnerable adults in compliance with the local authorities multi agency policies and procedures in order to safeguard people in their care. One safeguarding referral has been received by the home and is currently being dealt with by local authorities multi agency procedures. It was brought to the acting managers attention that a requirement had been made at the November 2006 key inspection that the proprietor and acting manager must ensure that all staff are trained in adult protection. This requirement had not been met at the random inspection in May 2007 and the timescale was extended. Whilst sampling staff files the inspector noted that a staff member had not received safeguarding vulnerable adults training and a further requirement has been made. Failure to comply with this regulation is an offence and may lead to enforcement action. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 23 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): 19, 20, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. The physical layout and indoor and outdoor communal of the home enable residents to live in a safe and well-maintained environment. Heating arrangements in the conservatory must be rectified. Resident’s bedrooms suit their needs and all areas of the home are clean and hygienic. EVIDENCE: During the tour of premises the inspector observed that the home was generally well maintained and appropriate access was available to all persons in the home. Whilst speaking with the residents in the evening they told the inspector that the heating in the conservatory was not working and although this had been reported no action had been taken. A requirement has been made that the Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 24 heating in the conservatory area must be restored in order that residents have adequate heating to ensure their welfare and wellbeing. The home employs a handy person who was in the home during the inspection and rectified a bedroom door, which was not closing appropriately and was also undertaking carpet cleaning in the home. Residents spoken with in their bedrooms told the inspector that they liked their bedrooms, which were comfortable. It was noted that people’s bedrooms were individualised and some contained their own items of furniture, personal possessions, leisure items including televisions, radios, and books. Some residents told the inspector that they had telephones in their rooms, which they enjoyed having in order to keep in contact with friends and family. The general atmosphere in the home was calm and orderly during the inspection and it was noted that the communal areas were spacious and bright which also included residents sitting in the conservatory during the morning. The home employs three housekeeping staff and it was observed that the home was clean and hygienic throughout. There was a slight malodour in the home on arrival at 07.30 but during the course of the day this was dispelled. The inspector observed that hand washing facilities were available and also disinfectant hand rub was located throughout the home in order to promote safe practice in regard to infection control. The inspector requested to see the homes infection control policy and procedure, which could not be located in the home. The acting manager assured the inspector that the home has a policy and when located it must be made available to staff in the home in order to promote and maintain good standards of hygiene. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 25 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): 27, 28, 29, 30. Quality in this outcome area is poor. This judgement has been made using a range of evidence including a visit to this service. Staff in the home are not fully trained and in sufficient numbers to support the residents at all times. The home does not have a robust system for the induction, training, development and recruitment of staff in order to ensure the safety and protection of residents in the home. EVIDENCE: The inspector was advised that the home is currently supporting 28 residents and employs 16 staff. The acting manager explained that no agency staff are employed by the home as the home has its own staff bank system. The staffing numbers on the day of the inspection included 3 care staff that commenced work at 07.00 whilst another staff member reported late on duty at 08.45. Four staff were on duty for the afternoon shift, which included on staff member working a 13-hour shift and a night care worker who had worked the previous night working from 15.00- 21.00. During the course of the inspection the inspector ascertained that two residents required two staff each time the resident required personal care support from staff for example using the hoist. Residents views regarding staff generally and the staffing levels in the home included ‘ the staff don’t have time to linger and they do their best as much as Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 26 they can but they need more staff as there’s a morning and evening rush’, my care is skimped due to lack of staff’. ‘Staff are kind and don’t hurry me’, ‘the staff have been very good when I’m not eating normally, here they try to cater for everyone’s needs, keep people clean, all are friendly and come from all different countries’. The inspector sampled staff rotas, which indicated that several staff are working excessive hours for example 64-66 hours per week and work 13-14 hour shifts. Several staff stated that they work extra as they did not want to let the acting manager down but stated they were unsure if they could continue to work such long hours. Staff expressed awareness that the long hours do not enhance quality of care for residents, as they could be tired and get ‘snappy’. Staff views regarding the proprietors awareness of the contribution of staff to the home was poor with staff stating that they do not feel recognised and valued by the proprietor for the work they do especially when he is overseas and staff cant contact him. It has been required that the staffing numbers are reconsidered and the duty rota revised to include more effective deployment of staff in order to ensure that residents needs are met at all times. The acting manager explained that the home employs a multi-cultural workforce and equality and diversity issues are addressed both by people living in the home and staff. It was brought to the acting managers attention that a requirement had been made at the November 2006 key inspection that the proprietor and acting manager must ensure that all staff files contain documentation in compliance with Schedule 2 and 4 Regulation 19 of the Care Homes Regulations. This requirement had not been met at the random inspection in May 2007 and the timescale was extended. The inspector sampled three staff recruitment files. Two files were for care staff and one file for housekeeping staff. All files contained application forms and evidence of face-to-face interviews conducted by the proprietor and CRB clearances. One care staff file contained a photocopy of a reference, which was not the referee noted on the application form and no other references could be located. The other care staff file contained one reference. It was noted that a letter contained in one staff file indicated that the individuals work permit expired in May 2007. Photocopied passports contained the individual’s photograph, which were not deemed to be up to date and a recent photograph of staff employed at the home must be obtained. The previous requirements made regarding the safe vetting practices of the recruitment of staff in order to ensure the safety and protection of residents in the home has not been met and a further requirement has been made. Failure Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 27 to comply with this regulation is an offence and may lead to enforcement action. In all three staff files sampled there was no evidence to support that staff had received a structured induction. One staff file contained a blank piece of paper, which was an induction checklist. The acting manager was unable to give an explanation regarding the lack of staff induction. The staff mandatory training records were sampled and evidenced that there were shortfalls regarding first aid training and lack of evidence to support staff awareness in health and safety. The three staff records indicated they had attended fire safety training with respect to a previous requirement. A requirement has been made that the home must ensure that persons employed by the registered person to work in the care home receive training appropriate to the work they perform including a structured induction to ensure that the homes staff are suitably trained and competent in their duties. It has been recommended that the home devise a matrix plan of training, which is easily accessible to determine the shortfalls and audit refresher training for staff. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 28 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): 31, 33, 35, 38. Quality in this outcome area is poor. This judgement has been made using a range of evidence including a visit to this service. The management and administration of the home is not robust. The home is run in the best interests of the residents. Resident’s general safety and welfare is promoted yet improvements need to be made regarding infection control standards. EVIDENCE: During the random inspection in May 2007 part of the focus of the inspection when assessing the management of the home was to ascertain the management arrangements within the home. It was confirmed that the previous manager left the home in October 2006. The homes senior carer has been acting as manager yet during the course of the inspection advised the inspector that they had informed the proprietor in writing that they did not Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 29 wish to be the registered manager. The commission has been informed that the acting manager has not attended an interview, has not been notified officially in writing that she is the manager, has not received and amended contract or job description and felt unsure of her present role. During the random inspection in May 2007 the proprietor gave the inspector assurances that the management arrangements of the home would be addressed as a matter of urgency and this assurance has not been met as the senior care worker is still in the position of the acting manager. The lack of confirmed management of the home was noted to undermine the authority of the acting manager and this was apparent during the inspection when a member of staff was asked to undertake a task as a matter of urgency and the instruction was ignored and undertaken in the staff members own time. Additionally two staff members one of whom was a senior care staff member arrived to work in incomplete uniforms e.g. wearing jeans. The inspector was made aware that some staff have specific agreements regarding their rotas and shifts are changed without consultation with the acting manager. Additionally some staff felt that there was as inequality within the workplace with some staff ‘getting away with’ being late and not working as part of the team, the inspector was advised that when this was addressed with staff members they either went to the proprietor or would not take notice of the acting managers authority in addressing the issues. During the course of the inspection it became apparent, and was evidenced by record keeping that several care workers were consistently arriving late for their duties without regard for the care of the residents welfare or their colleagues. Staff spoken with during the inspection told the inspector that they felt taken for granted and were treated badly by the proprietor who took no interest in the home and staff moral was low. Residents and staff spoke openly about their views of the current management arrangements and these included that some individuals felt there was conflict within the management of the home, some staff could not recall when the acting manager last had a day off, it was acknowledged how hard the acting manager worked. Residents stated they were unsure whom to approach regarding management issues, as they were unsure about the management arrangements in general. It has been required that the proprietor inform the CSCI in writing of the management arrangements of the home. The acting manager explained that the proprietor had sent out questionnaires to the residents and their relatives in order to seek their views about the home but she was unaware where the forms were. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 30 The inspector did not sample any of the homes financial accounting processes and was advised by the acting manager that the home does not safekeep residents money. The commission had received some comments of concern regarding the laundry system in the home which, indicated that the laundry services need to be improved as items of clothing have been mislaid. One resident told the inspector that the laundry service ‘was not very satisfactory as the wrong things come back’. During the tour of the premises the inspector observed that the laundry of the home was fairly orderly. The washing machine in the laundry was leaking and this was brought promptly to the handy persons attention and the acting manager to report the repair. On arrival at the premises the inspector was greeted by a staff member who opened the door wearing latex gloves, she advised the inspector that she had been supporting a resident at the time. The inspector observed another carer walking through the home with soiled laundry in their hands. When questioned they stated that there was nowhere to put the laundry and it was practice to bring the laundry down by hand to the laundry. The inspector observed that the home have red soiled linen bags yet these were not used on this occasion. As previously documented the inspector requested to see the homes infection control policy and procedure, which could not be located in the home and a requirement has been made that the home review the infection control practices in the home in order to prevent infection, toxic conditions and the spread of infection in the home. It was brought to the acting managers attention that on two occasions the inspector observed that cleaning fluids were left unattended whilst a housekeeper and handy man were attended to their tasks and it has been required that cleaning materials must be stored and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance in order to ensure the health and safety of residents. Records indicated that the home undertakes health and safety checks and an accident and incident book was sampled and evidenced that the home have reported the incidences to the CSCI under Regulation 37 notifications of any event that affect the well being and welfare of residents in the home. Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 31 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 1 2 1 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 2 X X 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 2 Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 4(1) (a-c) (2)(3)(ab) 5(1)(a-f) (2)(2a) (a-b) (3)(4) 5(a-b) 6 Schedule 1 5A (2) (a) (b) (3 ab) (3A) (4 a-b) 5B 14.(1)(a) (b)(c)(d) Requirement The home’s Statement of Purpose and Service User Guide must be updated. Copies must be made available to prospective individuals and people living in the home. Copies of both amended documents must be made available to residents and their representatives and copies sent to the CSCI local office. All residents must be fully informed of their terms and conditions of stay in the home, the fees and method of payment of fees. 14/01/08 Timescale for action 14/12/07 2 OP2 3 OP3 All prospective residents must 21/11/07 have a care needs assessment prior to admission to the home in order to ensure that the home could meet the individual’s needs. 14/11/07 4 OP7 OP8 15. (1) All residents must have a (2) (a) (b) documented care plan, which is agreed by the resident or their DS0000022964.V354363.R01.S.doc Chilworth House Version 5.2 Page 33 representative and kept under review in order to meet the needs and promote the welfare and wellbeing of residents. 5 OP7 12.(1) (a) The home must request a local authorities review regarding any resident’s care and ongoing suitability of placement in order to promote and make proper provision for the health and welfare of residents. The home must review the current risk assessments to ensure that all the hazards in residents daily lives are clearly documented, measures are in place to ensure their safety and well being and reviews are undertaken at appropriate times. Professional advice must be sought about the promotion of resident’s continence and acted upon and the current supply of aids reviewed for individual residents in order to ensure their needs are fully met. 14/12/07 6 OP7 13. (4) (a) (b) (c) 14/12/07 7 OP8 13. (1)(b) 14/12/07 8 OP9 13. (2) Robust arrangements must be 14/12/07 made for staff training, recording, handling, safekeeping, safe administration and disposal of medicines received into the home. Suitable arrangements must be made to ensure that the home is conducted in a manner, which promotes the residents rights to dignity and respect at all times. The home must inform the Commission for Social Care Inspection (CSCI) of the ongoing catering arrangements of the home to ensure that the home is DS0000022964.V354363.R01.S.doc 9 OP10 12. (4)(a) 16/11/07 10 OP15 18.(1)(a) (b) 23/11/07 Chilworth House Version 5.2 Page 34 appropriately staffed. 11 OP15 16. (2)(j) 13. (4)(c) The home must ensure that suitable arrangements are made for the disposal of kitchen waste and food must be stored in compliance with food safety regulations in order to protect residents from hazards to their health and well being. 23/11/07 12 OP16 22. (1) (2) 7. (a)(b) (8) The homes complaint procedure 23/11/07 must be updated and include the local CSCI details. A complaints log must be completed to detail a clear chronology of events for example dates of correspondence and outcomes regarding complaints received by the home. An update of outstanding complaints must be sent to the CSCI local area office. 13 OP18 13. (6) 18. (1)(a) The home must review their 14/11/07 policy and procedures regarding safeguarding vulnerable adults to reflect compliance with the local authorities multi agency policies and procedures in order to safeguard people in their care. The proprietor and acting manager must ensure that all staff are trained in adult protection. Timescales not met 31/03/07 & 31/05/07 31/12/07 14. OP18 18.(1) (a) 15 OP19 23. (2)(p) The heating in the conservatory area must be restored in order that residents have adequate heating to ensure their welfare and wellbeing. DS0000022964.V354363.R01.S.doc 21/11/07 Chilworth House Version 5.2 Page 35 16 OP27 18. (1) (a) The staffing numbers must be reconsidered and the duty rota revised to include more effective deployment of staff in order that residents needs are met at all times. The proprietor must ensure that copies of the information required by Regulation 19, Schedules 2 and 4 of the Care Homes Regulations 2001 (as amended 2006) are in every staff member’s file. Timescales not met 31/03/07 & 31/05/07 30/11/07 17 OP29 19 Schedule 2&4 31/12/07 18 OP30 18. (1)(c) The home must ensure that persons employed by the registered person to work in the care home receive training appropriate to the work they perform including a structured induction to ensure that the homes staff are suitably trained and competent in their duties. The proprietor must inform the CSCI in writing of the ongoing management arrangements of the home in order to ensure the effective management of the home and the safety and wellbeing of residents. The home must review the infection control practices in order to prevent infection, toxic conditions and the spread of infection in the home. Cleaning materials must be stored and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance in order to ensure the health and safety of DS0000022964.V354363.R01.S.doc 30/11/07 19 OP31 8. (1)(a) 8.(2)(a) (b) 26/11/07 20 OP38 13. (3) 26/11/07 21 OP38 13.(4)(a) 26/11/07 Chilworth House Version 5.2 Page 36 residents. 22 OP38 24 A plan must be provided to CSCI detailing how the home intends to improve the services provided in the home. 30/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations It is recommended that the Statement of Purpose and Service User Guide are made available to individuals with diverse needs for example sensory impairment and developed to large print or available in audio cassette in order that all individuals would have access to information in a format suitable to their needs. It is recommended that the format of the care plans be reviewed and expanded, for example, using one care need with identified goals and assessment with evidence of reviews having taken place at least once a month in order to ensure that the current needs of the resident are met. It is recommended that the home continue to introduce a person centred approach to care planning that would benefit the residents receiving care and support at the home. It has been recommended that the home devise a matrix plan of training, which is easily accessible to determine the shortfalls and audit refresher training for staff. 2 OP7 3 OP7 4 OP30 Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 37 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 © 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 Chilworth House DS0000022964.V354363.R01.S.doc Version 5.2 Page 38 - 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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