CARE HOMES FOR OLDER PEOPLE
Chine Breeze Court 73 Alumhurst Road Westbourne Bournemouth Dorset BH4 8HP Lead Inspector
Amanda Porter Key Unannounced Inspection 4th July 2006 10:00 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 Chine Breeze Court DS0000020438.V302167.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. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Chine Breeze Court Address 73 Alumhurst Road Westbourne Bournemouth Dorset BH4 8HP 01202 761307 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) Mr R Jenkins Mrs C Jenkins Mrs Jane Rosalie Morris Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named person (as known to CSCI) in the category MD(E) may be accommodated to receive care. 9th March 2006 Date of last inspection Brief Description of the Service: The registered providers are Mr and Mrs Jenkins. The registered manager is Mrs Morris who is a suitably experienced nurse. Chine Breeze Court is registered to provide nursing and personal care for a maximum of 19 older people in 15 rooms, 4 of which may be used as shared rooms by residents who have made a positive choice to share with each other. 4 of the 11 single use bedrooms have en-suite hygiene facilities. The accommodation is on two floors with a passenger lift serving both floors. The home is located in a residential area of Westbourne, Bournemouth within walking distance of local amenities and the sea at Alum Chine. The home is on the local bus route and has off road car parking at the front of the home. The weekly fee rates are £495 - £650. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the two days of the 4th and 5th July 2006 and took approximately five hours. The purpose of the inspection was to review the requirements and recommendations made in the last report and to assess all the key standards. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • A pre-inspection questionnaire completed by the registered manager. • Comment from visitors to the home. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. Five residents and four members of staff were spoken with and asked their views on the service provided at Chine Breeze Court. Comments received included: “Staff are very caring.” “My relative eats with great gusto – the food is good.” “The staff are very good.” “The staff work well as a team.” “I like working here.” All the staff and residents were welcoming and helpful. What the service does well:
Chine Breeze Court provides a very homely and comfortable atmosphere and residents are well cared for. They find that staff are kind, considerate and knowledgeable. The home carries out thorough assessments prior to residents moving in and assurances are given that individual needs can be met. There is a robust system for medication administration at the home. Residents said that the lifestyle experienced in the home matches their expectations and preferences. Residents are encouraged to maintain their links with family and friends and visitors to the home are made most welcome. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 6 The home offers a good variety of home cooked food, which is enjoyed by residents. The complaints procedure reassures residents that their views are important to the home and that any complaints they raise will be properly investigated. The house and gardens are generally well maintained and this provides residents with a very comfortable place to live. Residents are encouraged to personalise their rooms with small items of furniture, pictures and a variety of mementos. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. Mrs Morris is suitably qualified and experienced and manages the home well, with the support of her staff. Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff were protected by the policies and procedures that the staff followed at Chine Breeze Court at the time of inspection. What has improved since the last inspection?
The registered manager ensures that the needs of the residents moving into Chine Breeze Court are in line with the categories of care, for which the service is registered. The care planning system in place provides the staff with the information they need to meet the service users needs. The home ensures access to health care services to meet assessed needs and liaises with a variety of health care professionals such as GPs, consultant physician, district nurse, chiropodist and optician. Care is given which respects personal dignity, and residents’ rights to privacy. A new kitchen has been installed at Chine Breeze Court. A programme of refurbishment is continuing, which will improve the facilities at the home. A thorough recruitment process is followed when employing staff, which ensures that residents were protected from risk. Staff also receive adequate training to ensure they can meet the needs of the residents they care for. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 8 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 Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents move into the home having had their needs assessed and been assured that these needs will be met. EVIDENCE: There have been no new admissions since the last inspection. Care files for three residents were seen and each contained a pre-admission assessment, which provided sufficient information so that a plan of care could be drawn up. The manager confirmed in writing to each resident that their needs could be met. A relative confirmed that they were invited to view the home before making a decision about admission and given information about the home. The manager then undertook an assessment of the needs of the prospective resident before organising admission.
Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 10 Since the last inspection the manager has applied to the Commission for Social Care Inspection to vary the conditions of registration of the home to accommodate one resident whose needs were not inline with the categories of care Chine Breeze Court is registered for. This variation has been agreed because the manager proved that all the assessed needs could be met. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear, consistent care planning system in place, which provides staff with the information they need to meet residents’ needs. Residents’ health needs are met through visits from doctors and other health professionals as required. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure that residents’ medication needs are met. The staff treat people with dignity to ensure their basic individual rights are respected. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 12 EVIDENCE: Three care files were reviewed. They contained care plans, which accurately reflected the care given to the individual residents. Relevant assessments such as mental health, moving and handling and risk of falls were held on file and reviewed regularly. Where risk assessments identified a need for specialist equipment this was provided. Visits from health care professionals such as GP, clinical nurse specialists, optician and chiropodist were recorded in the care files. The home has a well-written and informative medicines policy and procedure including reference to self-administration and associated risk assessment and arrangements for ordering, administration and disposal. Medicines were stored securely. Records were kept of the receipt, administration and disposal of medicines. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Residents spoken with confirmed that staff were kind in their approach. Comments included: “They look after me very well.” “I am quite happy with the care my relative receives.” During the course of the inspection staff were seen to be going about their duties in a calm, cheerful and professional manner. They appeared courteous and helpful when engaging with residents. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an adequate range of social opportunities available in the home, which reflects residents’ interests and preferences. There is a strong sense of homeliness and inclusion of family and friends in life at Chine Breeze Court. Residents are helped to exercise choice and control in their daily lives within their capabilities and desire to do so. The dietary needs of residents are well catered for with a balanced and varied selection of food available that meets their tastes and choices. EVIDENCE: Care plans include information on residents’ interests and hobbies and activities are organised around assessed needs. However the record of activities attended was not up to date at the time of inspection. Activities include: • Outside entertainers performing at the home. • Quizzes. • Gentle exercises with Extend.
Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 14 Many residents benefited from visits from their families and this was seen as an important part of their care. Relatives said that they were always made welcome when visiting and they felt involved in care provided. They were invited to stay for meals with their relatives whenever they liked. Most residents were not able to, or chose not to, deal with their own financial affairs. In most instances family members dealt with this. Residents were able to bring personal possessions in with them to personalise their rooms. Residents and visitors to the home said “The food is very good.” Since the last inspection a new kitchen has been installed along with a new chef. The menu offers choice and the chef is aware of each residents dietary preferences. Although residents are told verbally what the menu offers a copy is not left with them for reference. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A written complaints procedure leaves residents in no doubt that steps will be taken to deal with any complaint or concern they may have. Staff’s knowledge and understanding of Adult Protection issues provides a safe environment to protect service users from abuse. EVIDENCE: The home has a clear complaints procedure available to everyone. No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection. Chine Breeze Court has a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Several of the staff had received training on abuse. Through discussion the management and staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Chine Breeze Court is good providing residents with an attractive, homely and safe place to live. The home provides a clean, pleasant and hygienic environment for the residents, staff and visitors. EVIDENCE: The home has a programme of routine maintenance. Records show that a variety of outside agencies have attended the home to undertake the routine maintenance of: • Fire safety equipment. • Gas installation. • Lift. • Hoists.
Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 17 The grounds are safe and attractive and accessible to residents. At the time of inspection the new kitchen was operational and awaiting inspection by the environmental health office. Further building work was being carried out to improve the premises. This will include decoration and the replacement of the floor in the laundry room. This will make cleaning the laundry much easier and reduce the risk of cross infection or contamination. Residents’ mobility needs are individually assessed and where mobility aids, such as zimmer frames, hoists and wheelchairs were needed they were made available. A call bell system is available in every room. The home was clean and free from any unpleasant odours. Residents and visitors confirmed that it was generally kept clean and tidy. The laundry is situated on the ground floor and has two washing machines and one tumble dryer. Care staff are responsible for undertaking laundry duties. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are employed and deployed to meet the care needs of residents. Residents would benefit from more staff having NVQ level 2 in care. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. EVIDENCE: Staff rosters demonstrated that there are sufficient staff on duty at all times. Visitors to the home said that they were grateful that the workforce at the home was permanent and many staff had worked at the Chine Breeze Court for a number of years. This meant that residents would receive the care they needed consistently. The home has an ongoing training programme, which includes NVQ level 2 in care. At the time of inspection 30 of care staff held this award, which is below the 50 recommended. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 19 Staff • • • • • • • recruitment files were reviewed and they contained: Completed application forms Two written references Enhanced CRB checks Terms and conditions of employments Documentary evidence of any relevant qualifications Proof of identity A record of the interview Training files demonstrated that healthcare assistants were receiving induction training. Records showed that staff had received mandatory training such as manual handling, food safety, first aid, health and safety and fire safety training. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run by a committed and competent manager, who creates an open and positive atmosphere, which supports good care practices for residents. Although the views of residents and visitors has been sought the information gained has not yet been used to formulate an annual development plan. Residents are assured of sound management procedures, which protect their financial interests. The health and safety of the service users and staff are protected by the policies and procedures followed at Chine Breeze Court. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home is well managed by Mrs Morris, who is supported by a loyal and consistent staff. Residents and relatives said that the manager was very approachable and if they had any concerns they would be happy to talk to her knowing that they would be listened to. The Registered Provider has recently sent out more satisfaction questionnaires to relatives to gain information, which would help formulate an annual development plan. Although the questionnaires had not been returned it was evident that all the residents and visitors to the home were listened to and their comments and suggestions were acted upon and generally the home was run in their best interests. The registered manager confirmed that residents were free to deal with their own finances but many preferred to have an appointed representative to do so. This is frequently another family member. Records showed that all staff had received recent training in fire safety and manual handling. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and analysed and appropriate action was taken as necessary. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 22 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 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 OP26 Regulation 13 (2) Requirement The laundry floor finishes must be impermeable and these and wall finishes must be readily cleanable. Timescale for action 03/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP12 OP12 OP28 Good Practice Recommendations The entries in the activities records for residents should be kept up to date. A copy of the activities programme and the menu should be circulated to residents. It is recommended that 50 of care staff should have qualifications equivalent to NVQ level 2 in care. Chine Breeze Court DS0000020438.V302167.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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