CARE HOMES FOR OLDER PEOPLE
Chine Breeze Court 73 Alumhurst Road Westbourne Bournemouth Dorset BH4 8HP Lead Inspector
Carole Payne Unannounced Inspection 9th March 2006 10:30 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 Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 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.V285614.R01.S.doc Version 5.1 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.V285614.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd August 2005 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 to a maximum of nineteen older people in fifteen rooms, four of which may be used as shared rooms by residents who have made a positive choice to share with each other. Four of the eleven single use bedrooms have en-suite facilities. The accommodation is arranged 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 parking at the front of the home. Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on the 9th March 2006 and took a total of 7.5 hours. The inspectors, Carole Payne and Amanda Porter were made to feel welcome in the home during the visit. The manager, Mrs Morris, and one of the providers, Mrs Jenkins, were present during the inspection. This was a statutory inspection and was carried out to ensure that the nineteen residents who were living at Chine Breeze Court were safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit were reviewed. Since the last inspection no formal complaints against the home have been received or investigated. The premises were inspected and records examined. Time was spent in discussion with people living at the home, the management team and staff members on duty. Eight residents were spoken with and residents were observed enjoying the communal areas and spending time in individual rooms. What the service does well:
The home carries out detailed pre-admission assessments, prior to residents moving into the home. The manager confirms in writing with the resident and / or their family member, that the home is able to meet their needs. A friend of a resident commented ‘we did not want to look anywhere else when we had visited Chine Breeze.’ A care plan, which reflects residents’ needs, wishes and preferences, supports the delivery of care to those people who have been living in the home for several months or more. People living in the home, and families, are invited to be a part of planning care. There is an adequate range of social opportunities available in the home, which reflects residents’ interests and preferences. A strong sense of homeliness supports the inclusion of family and friends in the life of the service. Residents are well supported to exercise choices and control over their lives. People living in the home receive good home cooking; enjoyed in a range of surroundings, at times which are acceptable to them. ‘The food is good’ a resident commented. Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 6 The home has policies, procedures and effective training in place, which protects residents from abuse. The manager of the home has recently achieved a care management degree in care. The effective working relationship of the manager and the providers together with consultation with people living in the home, contribute to the running of the home in the best interests of residents. The manager had been routinely updating and reviewing policies and procedures, to reflect current good practice. Staff members are regularly updated in food hygiene, manual handling, health and safety and first aid; promoting safe working practice. Records for the routine checking of equipment and facilities show that items are routinely monitored and maintained. What has improved since the last inspection?
Progress is being made to ensure that care plans reflect the health, personal and social care needs of residents. There is now a written policy and procedure with regard to the use of shared rooms. The policy regarding dying and death has been improved to ensure accuracy and clarity, as recommended in the last inspection report. The provider stated that new furnishings, carpets, sheets, blinds and curtains had been purchased and are part of the home’s continuing plan for improvement. At the time of the visit a new kitchen was being installed to the rear of the property. A suitable assessment has been carried out by an occupational therapist since the last inspection. Progress is being made with minimising the risk of scalding from potentially hot and uncovered radiators. Thermostatic control valves have been fitted to radiators. The manager confirmed that appropriate risk assessments are in place and there is a plan to fit covers to all radiators in the home. Good standards of cleanliness supported the sense of homeliness throughout the service. The home’s certificate of registration is now satisfactorily displayed in the home. Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 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.V285614.R01.S.doc Version 5.1 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.V285614.R01.S.doc Version 5.1 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 Prior to assuring residents that the home is able to meet their needs, a thorough assessment is undertaken. In the case of one resident who had recently moved in, the service had failed to ensure that the needs of the person were in line with the categories of care, for which the service is registered. EVIDENCE: A detailed pre-admission assessment had been carried out for two residents who had recently moved into the home. There was a thorough account of medical history and in relation to all aspects of daily living. A letter was also seen on two files confirming with the resident / their family member, that the home was able to meet their needs. A pre-admission room checklist ensures that residents’ rooms are prepared and welcoming when new people move into the home. The records of assessment and care planning for a resident who had recently moved into the home, demonstrated that the person had care requirements, which fall outside the service’s categories of registration.
Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 10 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, 10, 11 Progress is being made to ensure that care plans reflect the health, personal and social care needs of residents. The manager is committed to ensuring that in the future care plans are drawn up promptly and that they effectively support people in the first months of settling in at the home. Generally residents are treated with respect for their privacy; one staff member failed to adequately protect the dignity and privacy of residents occupying a shared room. The service has good procedures in place, which support the care of terminally ill residents and their families. EVIDENCE: Progress is being made with reflecting the needs and wishes of residents in planning the delivery of care. One relative said ‘I can look at the care plans whenever I like.’ Copies of letters on file invited people to attend reviews of care plans. However, one care plan had been written one week after the person had moved into the home, a second four days following admission.
Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 11 Two care plans for residents who had moved in, in the previous two months, failed to detail sufficiently how and when assistance was to be provided. For example in relation to social care, a plan stated that the key worker was to identify possible activities of interest; another asked that the resident should be consulted about food likes and dislikes. Psychological support was not detailed in the care plans for two residents requiring this aspect of care. Care plans detailed nutritional risks, including concerns regarding weight loss, previous dehydration and poor food intake. Care plans specified particular monitoring required. Fluid charts detailed output. They did not record food intake, fluids offered, or refused, and there was inadequate monitoring of weight. The manager said that the home’s scales had been out of order and had been recently returned. Throughout the visit staff members were observed caring for residents with respect for their privacy and dignity; knocking on doors, explaining care before providing assistance and being sensitively reassuring, both to residents and their families. The door of a shared room had been left open during the visit. A resident was sat on a commode chair, covered by a towel and the person sharing the room was sat in a nearby chair. There was no privacy screen in place. A care plan detailed the providing of personal care, whilst a resident is using the commode. There is now a written policy and procedure with regard to the use of shared rooms. Although this does not currently involve the seeking of the written consent of both residents, or their representatives, the manager outlined the consultation process which had taken place when a new resident had recently moved into the home and was sharing a room with a person who was already living in the home. The manager confirmed that she would ensure that there was a written record of discussions, including the obtaining of consents in the future. The policy regarding dying and death has been clarified, as recommended in the last inspection report. The policy refers to meeting the needs of a dying resident who is sharing a room, including the consideration of the wishes of both residents occupying the room, and referral to a sensitive and compassionate approach to the management of care. Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 12 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 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 the life of the service. Residents are well supported to exercise choices and control over their lives. People living in the home receive good home cooking; enjoyed in a range of surroundings, at times which are acceptable to them. EVIDENCE: Care plans included reference to residents’ social interests, hobbies and personal histories. Individual records of social contacts are maintained. The companionship time spent with residents is not always recorded; this was, however, seen to be an important part of good care on the afternoon of the visit. Reference is also made to the right to access care plans. One relative spoke about this involvement in the care of their family member. One of the members of care staff outlined the range of activities available. These include extend, visiting singers, and walks in the garden in the warmer
Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 13 weather. On a notice board there were details of a forthcoming fashion wear event. Staff members spoke quietly and companionably with residents who were staying in their own rooms. There are a variety of communal areas where residents can enjoy the television, a quiet sit, and private time with relatives, perhaps watch the fish in the home’s fish tank, or, enjoy the pleasant views of the home’s garden from the conservatory. One of the resident’s rooms had treasured photographs on the wall by the bed, where the resident could enjoy them. Rooms were personalised and there is a sense of warmth throughout the service; of ‘homeliness’ as one visitor described. A relative said ‘I feel so welcome when I come here.’ The home’s cook was busy in the kitchen preparing lunch on the day of the visit. This included fresh vegetables. She said that there is a single choice of main meal, but she is happy to prepare alternatives according to residents’ individual preferences. There is a choice of pudding. In the evening there are hot and cold alternatives. One resident said ‘the food is good’. The menu is displayed in the home. At lunchtime three residents ate in the dining room, some residents ate in the lounge; others dined in their own rooms. Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 14 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): 18 The home has policies, procedures and effective training in place, which protects residents from abuse. EVIDENCE: A member of staff working in the home-demonstrated knowledge of appropriate action to be taken in the event of a case of suspected abuse. Most staff members have now completed a National Vocational Qualification and, as part of that, have undertaken training in adult protection. Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 15 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, 22, 25, 26 Residents’ personal accommodation was in an adequate condition. There is a significant programme of improvement to the environment in progress. A suitable assessment has been carried out by an occupational therapist since the last inspection. Progress is being made with minimising the risk of scalding from potentially hot and uncovered radiators. Good standards of cleanliness supported the sense of homeliness throughout the service. EVIDENCE: At the time of the visit major work was taking place to improve the living environment and its facilities. The manager was ensuring that the work being carried out caused the minimum of disruption to the people living in the home. Residents’ accommodation seen was in a satisfactory condition and was personalised with chosen furnishings, and possessions.
Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 16 The home has recently had an assessment of the premises by an occupational therapist and was working upon the recommendations made as a result of the assessment. The manager said that since the last inspection thermostatic valves had been fitted to radiators. She confirmed that risk assessments are appropriately in place and that a plan is in place to fit covers to all radiators in the home. A warm, comfortable temperature supported the sense of homeliness in the service. All areas of the home visited were clean and free from offensive odours. A member of domestic staff was busy during the course of the morning, and clearly took pride in her role. Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 17 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 The numbers and skill mix of staff satisfactorily meets the needs of people living in the home. Staff members receive effective training to support the meeting of residents’ needs. Residents are not consistently protected by the home’s recruitment practises. EVIDENCE: On the morning of the visit the manager said that members of the senior care team were on a training course. Despite this, she led the team on duty effectively and residents’ needs were met. One visitor commented that staff had ‘time to listen.’ A resident said ‘The staff are great.’ A roster is maintained. The manager was advised not to use tippex on the record, so that there is clear documenting of duty allocation, including any changes or alterations. There are domestic staff members on duty seven days per week and a cook is on duty each day. The manager confirmed that all care staff, aside from two, now holds a National Vocational Qualification in care. One of five recruitment files contained one, rather than two. A file for a member of the care team contained a standard Criminal Records Bureau
Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 18 disclosure from a previous employment. Other application records contained the required documentation, including an enhanced Criminal Records Bureau check. Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 19 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, 32, 33, 35, 37, 38 People live in a home, which is well managed, by a person with the qualities and experience to fully carry out the responsibilities of the post. Residents benefit from the effective working relationship of the providers and manager, which is reflected in the ethos of the home. The service consults with people involved in the life of the home, which support the running of the home in the best interests of residents. The home protects the financial interests of people living in the home. The rights and interests of residents are safeguarded through the review of policies and procedures. Training and practice promote and protect the health and welfare of residents. Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 20 EVIDENCE: The manager of the home said that she had recently achieved a care management degree in care. Throughout the visit she liaised regularly with care staff, directing and leading the staff team on duty. She responded professionally and sensitively to residents’ needs. One of the providers of the home, Mrs Jenkins, was also present. Both the manager and provider spoke of their shared commitment and their effective relationship, was demonstrated in the positive outcomes for people living in the home. Two visitors spoken to say that they feel involved in the life of the home, commenting that they are consulted about what is happening, both in relation to their relatives and generally about their views. An external auditing tool has been adopted by the home and the manager said that she had recently sent out questionnaires to ask people what they think about the service. She confirmed that she would collate the results, and respond to any issues highlighted. Staff members spoken to said that they have opportunities to meet together and feel part of a ‘team.’ The manager said that no personal monies are routinely held for residents. The provider also said that the home does not act as an appointee for any person living in the home. The home’s certificate of registration is now satisfactorily displayed in the home. The manager had been routinely updating and reviewing policies and procedures in place in the home, to reflect current good practice. Records for the routine checking of equipment and facilities showed that items are routinely monitored and maintained. Discussions with staff regarding training, and records of training on individual files reflect regular updating in food hygiene, manual handling, health and safety and first aid. Staff working during the afternoon of the visit, demonstrated competence and knowledge of safe working practices. Whilst a new kitchen was being built, a smaller kitchen was being used off the main cooking area for washing up. The faded grey colour of cloths and tea towels was not in line with the high standards of cleanliness and infection control in other parts of the home. The manager said that this would be immediately addressed. She confirmed that a representative from the Environmental Health department had visited, and was aware, and satisfied, with the interim arrangements, whilst the new kitchen was being installed. Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 21 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 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 3 Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 Page 22 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 OP4 Regulation 4, 12, Schedule 1(6) Requirement An application for variation must be made to accommodate a resident whose needs are not in line with the home’s categories of registration as stated in the home’s statement of purpose. The service must not admit any resident, for which the home is not registered to provide care. A care plan must be drawn up so that the needs of residents who have recently moved into the home can be met. As identified by assessment, psychological support required, must be detailed in care plans. Where residents are identified to be at risk there must be monitoring of food and fluid intake and weights. The privacy and dignity of residents must be maintained; with particular reference to people occupying shared rooms.
DS0000020438.V285614.R01.S.doc Timescale for action 12/04/06 2. OP7 12, 15 28/04/06 3. OP8 12 07/04/06 4. OP10 12(4) 07/04/06 Chine Breeze Court Version 5.1 Page 23 5. OP29 19 and schedule 2 There must be evidence that the home operates a robust recruitment procedure. New staff must not commence work in the home without evidence of suitable CRB and POVA disclosure. (Previous timescale of 22.08.05 not met.) 07/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chine Breeze Court DS0000020438.V285614.R01.S.doc Version 5.1 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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