Inspection on 15/05/06 for Chiswell Residential Home

This inspection was carried out on 15th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chiswell Residential Home 20/04/07

Chiswell Residential Home 28/09/05

Chiswell Residential Home 25/05/05

Chiswell Residential Home 28/10/04

Chiswell Residential Home 24/08/04

Chiswell Residential Home 15/03/04

Chiswell Residential Home 16/06/03

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE Chiswell Residential Home 193 Watford Road St. Albans Hertfordshire AL2 3HH Lead Inspector Yoke-Lan Jackson Key Unannounced Inspection 15th May 2006 11:00 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 Chiswell Residential Home DS0000019314.V295463.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. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chiswell Residential Home Address 193 Watford Road St. Albans Hertfordshire AL2 3HH 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) 01727 856153 01727 848472 Mrs S Dewing Mrs S Dewing Care Home 6 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (5), Old age, of places not falling within any other category (6) Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The registration category of MD(E) applies only to the five service users currently resident in the home. All care staff must receive certified training in Mental Health Care. Once the existing five service users permanently leave the home for any reason, the registration category will revert exclusively to Old Age category. 28th September 2005 Date of last inspection Brief Description of the Service: Chiswell Home, opened in 1996, is a residential care home registered for 6 service users in the Older People category. However, there are specific conditions attached to the registration in relation to 4 service users with a mental health condition. The home charges £589 - £627 per week. The home is located in Chiswell Green, on the outskirts of St. Albans, close to local shops and other amenities. There are some parking spaces on the front driveway and on the side road nearby. The two-storey detached house provides 2 bedrooms on the ground floor and 4 bedrooms on the first floor. Each bedroom has a washbasin. The bathroom and toilet facilities are nearby. The kitchen, the lounge and the dining room are all on the ground floor. The small administrative office is on the first floor. The home has a front lawn and an attractive garden with a patio to the back of the building. There are garden furniture and comfortable seating which are accessible to the service users. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on 15/05/06 in addition to 2 preceding monitoring visits. Currently the home is registered for service users in the Old Age Category. However, the proprietors hope to include the Mental Health Category in their registration with the Commission for Social Care Inspection (CSCI) in the near future. The home has 4 service users and 2 vacancies. There is a prospective service user waiting for admission. In view of the nature of the situation, the registered manager has applied to the Commission for a variation to admit this prospective service user. (Please see below for details of the inspection findings). What the service does well: What has improved since the last inspection? The written care plan of each service user has been revised and reviewed to reflect their care needs. The registered manager ensures that all written care plans are reviewed regularly and that they are kept up to date. The registered manager has organised accredited training in mental health issues for all the staff. This will further enhance their skills in caring not only for service users who are in the old age category but also for service users with mental health conditions, such as depression, anxiety and schizophrenia. One of the service users has been transferred to the vacant bedroom on the ground floor to accommodate her impaired visual disability and restricted mobility. The home does not have a lift. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 6 The patio in the back garden has been cleared of hazards to safety and is made readily accessible to the service users. The greenhouse is being repaired and will be used as a base for gardening activity for the service users. 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. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 7 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 Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 8 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): 1, 3, 4 (Standard 6 does not apply to this home). New service users are admitted only on the basis of a full assessment to ensure that all their needs can be met. Each service user is given detailed information of the service provided in the form of a Service User Guide. (Quality in this outcome area is Adequate. This judgement has been made using available evidence) EVIDENCE: The home has a revised Statement of Purpose, a copy of which was submitted to the Commission. Each service user was given a Service User Guide. The registered manager had conducted a pre-admission assessment on a prospective service user, who will have a trial period of stay if admitted into the home. This admission is subjected to a variation application which has been submitted to the Commission (CSCI) for consideration. The home will only admit service users whose needs can be met. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 9 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. There is a written care plan for each service user to ensure that the service user’s health, personal and social care needs are being met. The service users in the home are treated with respect and dignity. The medicines are administered in accordance with legislation. (Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service) EVIDENCE: The home has revised the format for the written care plan to ensure that all aspects of the health, personal and social care needs of each service user are clearly documented and updated. The registered manager ensures that the care plan is drawn up at the point of admission and that it is signed by the service user (and/or his relative or representative). The care plan is reviewed monthly and updated to reflect the changing care needs of the service user. A plan of action to meet any changing care need is then devised. Risk assessment is in place. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 10 All service users have access to specialist services according to their needs. One service user is currently on antibiotics and she is encouraged daily to elevate her oedematous legs to improve blood circulation. Her General Practitioner is actively involved in her health care needs. One service user has been referred to the specialist nurse in regard to the management of continence. The service user with partial sight impairment has access to sight tests and appropriate aids. She had recently moved to the vacant bedroom on the ground floor to accommodate her restricted mobility. She has settled down in her new environment. Trained staff administer the medicines to the service users. All medication records are kept in accordance with legislation. The home uses the Normad System for each service user. All medicines are clearly labelled and marked with the opening date written on each container. One service user has her blood monitored regularly by the District Nurse in view of the medication she is prescribed. The staff have demonstrated their caring attitude to all the service users. The service users are treated with respect and dignity. They appeared content and happy and were well cared for. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 11 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. The service users have choices in the daily living routine in the home. Their preferences are respected. The activities provided are stimulating. Service users have close links with their family and friends. The meals provided are nutritious and wholesome. Choices are given daily. (Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service) EVIDENCE: The inspector visited the home on several occasions. It was evident during these visits that the service users were encouraged to participate in stimulating activities. On the day of the inspection, the service users were involved in singing and dancing encouraged by an instructor. Another event on the same day involved 2 pet dogs trained especially for the activity. This stimulating session has been on-going for a number of years. All the service users enjoy engaging in this activity. The service users have their nails manicured every 2 weeks by a professional, who was present on the day of the inspection. All visiting professionals gave Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 12 very positive feedback about the staff, the care and the services provided in the home. Staff interviewed confirmed that service users have walking exercises and that they are often taken out to the local shops. Sightseeing and other day trips are usually arranged for the summer months. Service users are given choices and encouraged to get involved in the daily routine in the home. One service user has regular visits from her spouse. On the day of the inspection the couple had tea together in the sitting/dining room. The service user was offered the choice to have tea with the other service users or have her tea with her visitor. Privacy was maintained. The other service users were in the first lounge. Mealtimes were observed to be pleasant and unhurried. The member of staff was readily available to offer assistance in a discreet and caring manner. The dishes presented were appealing and appetising. All the service users appeared to enjoy themselves. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 13 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, 17, 18. The home has a complaint policy and procedure in place. Service users are protected from abuse. (Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service) EVIDENCE: The home has not received any complaint since the last inspection. Staff have training on issues concerning the protection of vulnerable adults (POVA). The recent POVA training was held in November 2005. The home follows the procedure set up by Hertfordshire Social Services. All staff have had their Criminal Record Bureau checks and clearance. Two members of staff will have their CRB checks repeated at the due date. Service users have access to advocacy services and they are able to exercise their legal rights. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 14 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, 20, 21, 24, 25, 26. The service users live in a safe, homely and comfortable environment. The internal and outdoor communal facilities are kept safe and accessible to all the service users at all times. (Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service) EVIDENCE: The registered manager has rectified the health and safety issues pointed out during the monitoring visit on 21/04/06. The patio was cleared of all objects that are a hazard to safety within 2 days. The garden furniture is appropriately placed and the service users have safe access to the garden facilities. The registered manager has made arrangements for the greenhouse to be repaired this week. It will be transformed into a sensory garden and a base will Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 15 be provided for the service users to get actively involved in seed planting and other garden activities. The interior of the home has been maintained appropriately. All the bedrooms have been redecorated. A loose toilet seat has been repaired. The door hinges have been replaced. The registered manager has made arrangements for all the hot water taps and the thermostat to be serviced this week to ensure that the water temperature is constantly maintained at 43 degrees centigrade. A record is now kept of the hot water temperature and regular checks are being made. The registered manager ensures that all hazardous substances are stored in a locked cupboard when not in use, in accordance with legislation. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 16 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. The home has an effective and dedicated team of workers. The skill mix of the staff benefits the service users. The staff have the required training to enhance their skills in the care of the service users. The home’s recruitment policy and practices comply with legislation. (Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service) EVIDENCE: The home has experienced staff of long standing. The registered manager herself is a trained nurse in mental health and the deputy manager is also a trained nurse. Two of the carers have worked as nursing auxiliaries at Cell Barnes before its closure. They were involved with the care of service users with challenging behaviour for many years prior to working in the home. Staff have commenced accredited training on mental health issues to enhance their knowledge and skills in meeting the needs of the service users in their care, some of whom have mental health condition. The accredited training programme on ‘Schizophrenia’ took place on 29/03/06. Further training session including “Depression, Anxiety and Challenging Behaviour” will commence in June 2006. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 17 The deputy manager has enrolled for the ‘Mental Health Care’ course at Hertfordshire University and she will commence her training this year. In addition to the current training programme, the home has close links with the local Community Psychiatric team and one of the psychiatric nurses has been giving training on mental health issues to the staff on a regular basis. There were teaching and discussion on ‘basic care and respecting the opinion and choices of the service users in the home’. The in-house training by the CPN has included topics such as ‘The Mental Health Act’ and ‘Activities for the Elderly with Mental Health problems’ Further training has been arranged for 02/06/06 with the same specialist nurse. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 18 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, 37, 38. The standard of care and services provided are maintained in a positive way. The health and safety of the service users and staff are promoted and protected. The registered manager has put in place a quality monitoring system. Records for the protection and effective management of the home have been updated. (Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service) EVIDENCE: Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 19 Currently the home is registered for service users in the Old Age Category. However, the proprietors hope to include registration in the Mental Health Category. One of the 2 proprietors is the registered manager of the home. She is an experienced and trained nurse in mental health. The home is run in the best interest of the service users who seemed content and well cared for. The members of staff interviewed confirmed that they are meeting the needs of the service users in spite of their mental health conditions. The registered manager ensures the health and safety of the service users and the staff. It was evidenced during the inspection that the premises have been cleared of hazards to safety. Appropriate repairs and redecoration of the interior have been carried out. The registered manager has put in place a quality assurance and monitoring system. Questionnaires were sent to the service users, relatives, neighbours and other professionals for their feedback as part of the yearly audit. The registered manager has assured the inspector that all policies and procedures are currently being updated. There is a business and financial plan that is readily available to inspection. The home is not involved in the financial affairs of the service users except for the personal allowance. All transactions are appropriately documented. Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 2 3 X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation Section 24 Care Standard Act 2000 Requirement Admitting a service user who falls outside the registration category is an offence under Section 24 Care Standards Act 2000. In view of the current situation, the registered manager is required to submit to the Commission an application for variation to admit a prospective service user with Mental Health condition. Timescale for action 15/05/06 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 Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chiswell Residential Home DS0000019314.V295463.R01.S.doc Version 5.2 Page 23 - 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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