Inspection on 25/05/05 for Chiswell Residential Home

This inspection was carried out on 25th May 2005.

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

Chiswell Residential Home 20/04/07

Chiswell Residential Home 15/05/06

Chiswell Residential Home 28/09/05

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 Bijayraj Ramkhelawon Unannounced 25 May 2005 10:30 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 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 I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Chiswell Residential Home Address 193 Watford Road St Albans Hertfordshire AL2 3HH 01727 856153 01727 848472 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs S Dewing Mrs S Dewing Care Home 6 Category(ies) of OP Old Age 6 registration, with number of places Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22 February 2005 Brief Description of the Service: Chiswell Home is a care home providing personal care and accommodation for 6 older people.It is owned and managed by Mrs Dewing. The home is located in Chiswell Green, on the outskirts of St. Albans, close to shops, pubs, the Post Office and other amenities. The home was opened in 1996 and consists of a two-storey building with service users accommodation arranged on the ground and first floor.All the home’s bedrooms are single accommodation. There is no passenger lift. The home has a car parking area at the front and a pleasant garden to the rear. Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this inspection, it was noted that some changes have been made to meet the requirements made in the previous inspections. However, many of these were not complied with. The majority of time was spent inspecting the environment, talking to service users and staff. Some time was spent scrutinising care plans, and other records. Discussions were held with the deputy manager to whom the feedback of the inspection was given. The experience of service users was that they were complimentary of the staff, the food and their rooms. What the service does well: What has improved since the last inspection? 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 I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 7 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 standard(s) 1-5 Adequate information was available to prospective service users and their relatives to assist them in their decision making process when chosing the home. Assessment of needs carried out by the home prior to an offer of placement is made did not include all the needs of the service users especially in relation to their Mental Health Needs. These must be completed and signed by a trained staff. The registered provider and manager have both failed to understand that the home is not registered to admit people with mental health problems. Good observations were made of staff’s approaches and attitudes to service users and to the appropriateness of their delivery of care. EVIDENCE: The home has a written ‘Statement of Purpose and a ‘Service User Guide’ and both documents were available to prospective and current service users and their relatives. There was evidence in the care plans scrutinised that a preadmission assessment of needs of the service users were carried out but these did not reflect the mental health needs of the service users who have mental health problems. Neither were the assessment forms fully completed nor signed and dated by the assessor. Half the number of service users in the care home have mental health problems and are being treated with antipsychotic medication. The home is not registered for people with psychiatric problems. Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 8 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 standard(s) 7-11 Care plans were reviewed regularly to reflect the changing needs for health, personal and social care needs of the service users. Records of medicines including the receipt, storage and disposal were kept in good order. However, there were shortfalls in the procedures for dealing with these. EVIDENCE: Care plans had adequate information required by this Standard and were reviewed regularly. All service users were registered with a GP, who refers service users to all other health care agencies as and when required. Records of medicines including the receipt, storage and disposal were kept in good order. However, the home does not have a procedure in place to ensure that staff have sight of the original signed prescription before it is dispensed and a copy is retained. The home’s medicine policy and procedures does not include that medicines must be retained for 7 days after the death of a service user. It was noted that hand-written changes or additions to medication profiles or instructions were not signed and dated by the person making the entry. Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 9 All service users were appropriately dressed and were correctly addressed by staff. Staff members on duty were observed to deliver care and to attend to service users’ needs in a manner that is conducive to respect for their privacy, dignity, choice and wishes whilst actively promoting independence where possible. All personal and intimate care practices were carried out in service users bedrooms. Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 10 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 standard(s) 12-15 The home promotes autonomy and choice. Visitors are welcomed and the home promotes integration with the local community in accordance with service users preferences. EVIDENCE: The home provides limited activities for service users. On the day of the inspection, they were watching T.V in the lounge. Service users personal allowances were managed by the home and receipts for expenditures were kept. Personal belongings were evident in service users bedrooms. Confidential and private information was locked away and care plans were securely stored. The home has a menu and service users spoken to were complementary of the food provided. Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 11 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 standard(s) 16-18 The home has a complaints procedure. It was difficult to establish from the service users whether they were aware of this policy. EVIDENCE: A copy of the complaints procedure was available to prospective and current service users. Those spoken to could not say whether they were aware of the complaints procedure. However, neither the home nor the Commission has received any complaints since the last inspection. Staff confirmed they were aware of ‘ Protection of Vulnerable Adults Procedure’ and the ‘Whistle Blowing Policy’. Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 12 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 standard(s) 19-26 The home and its surroundings offer a comfortable and safe environment to its service users. However, the internal décor needs attention including some repair work. The home was kept reasonably clean and bedrooms were personalised offering a homely, lived in feel. The registered manager must make suitable arrangements to prevent and spread of infection at the care home and must identify and eliminate the lingering odour in bedroom 5. EVIDENCE: Most of the bedrooms were kept clean and contained service user’s personal furniture and belongings. However, there was a lingering odour in bedroom 5 and the wardrobe was broken too. It was noted that there were patches of badly stained wallpapers in the dining room and the lounge, which were peeling, off the wall. It was also noted that there was badly stained, worn and wet carpet in the bathroom. Terry towels were still being used and the home must make suitable arrangements to prevent the spread of infection by providing alternative hand drying facilities and liquid soap. Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-30 The skills and experience of staff is varied. There was a dedicated and caring staff team who took great pride in the service provision. Staff files must be available for inspection. EVIDENCE: There was adequate numbers of care staff rostered on duty per shift during the day and night. Service users were complimentary about the staff and they said ‘they were well after’. Staff files were not inspected on this visit as these were not available. Staff spoken to confirmed that they have received appropriate training including the mandatory training. Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31-38 The management of the home is very reactive rather than proactive. The staff who have direct involvement with the service users appear to be dedicated to providing a good service. The home must provide appropriate facilities for communication by facsimile transmission and must have a system for reviewing and improving the quality of care. It should also provide receipt when money is handed over to staff by relatives for service users. EVIDENCE: The management of the home have not been compliant in meeting the requirements and recommendations of the previous inspection reports. However, the home is endeavouring to have systems and processes in place but these are very slow. The home does not have a facsimile facility for communication nor it has developed a system for reviewing, monitoring and improving the quality of care. It was noted that when money is handed over by relatives, no receipts are given to them. Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 15 Records inspected were up-to-date and accurate and were held securely. Staff spoken to were aware that service users can access their records and information held about them in accordance with the Data Protection Act 1998. A valid insurance certificate is displayed in the reception area and this offers cover of no less than £5 million. Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 1 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 1 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 1 3 3 3 2 3 2 1 Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 17 yes 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 OP 3 Regulation CSA, S24 Requirement The registered provider and the registered manager must not admit service users whose needs fall outside the registered category. All assessments and health forms completed by staff must be signed and dated by the person making the entry. Ensure a procedure is in place such that the staff have sight of the original signed prescription before it is dispensed and a copy retained. Medicine policy and procedure should include that medicines must be reatined for 7 days after the death of a service user. Broken wardrobe in bedroom 5 must be repaired. Badly stained wall paper which is peeling off the wall must be replaced. Badly stained, worn and wet carpet in the bathroom must be replaced. Lingering odour in bedroom 5 must be identified and eliminated. The registered manager shall make suitable arrangements to Timescale for action Immediate and Henceforth 23/07/05 2. OP 3 14(1)(a) 3. OP 9 13(2) 23/07/05 4. OP 9 13(2) 23/07/05 5. 6. 7. 8. 9. OP 19 OP 19 OP 26 & 38 OP 26 & 38 OP 26 16(2)(c) 23(2)(b) 23(2)(b) 16(2)(k) 13(3) 23/07/05 26/08/05 26/08/05 23/07/05 23/07/05 Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 18 10. OP 29 & 37 17(2) &19(1)(b) 11. OP 31 16(2)(a) (ii) 24(1)(a)& (b) 12. OP 33 prevent and spread of infection at the care home:a) By providing alternative hand drying facilities to that of terry towels. b) By providing liquid soap. All staff must have documents 26/08/05 specified in paragraphs 1 to 6 of Schedule 2 and 6 to 7 of Schedule 4. This documentation must be kept in the home and must be available for inspection. The registered manager must 26/08/05 provide appropriate facilities for communication by facsimile transmission. A system for reviewing and 26/08/05 improving the quality of care must be established and maintained. 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 OP 9 OP 35 Good Practice Recommendations Hand-written changes or additions to medication profiles or instructions should be signed and dated by the person making the entry. Receipt should be given when money is handed by realtives for service users. Chiswell Residential Home I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City 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 I52 s19314 chiswell v229734 250505 stage 4.doc Version 1.30 Page 20 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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