Inspection on 28/09/05 for Chiswell Residential Home

This inspection was carried out on 28th September 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 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 15/05/06

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 Bijayraj Ramkhelawon Unannounced Inspection 28th September 2005 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 Chiswell Residential Home DS0000019314.V260934.R01.S.doc Version 5.0 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.V260934.R01.S.doc Version 5.0 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 Old age, not falling within any other category registration, with number (6) of places Chiswell Residential Home DS0000019314.V260934.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th May 2005 Brief Description of the Service: CONDITIONS OF REGISTRATION:1. The registration category of MD(E) applies only to the five service users currentlyu resident in the home. 2. All care staff must receive certified training in Mental Health Care. 3. Once the existing five service users permanently leave the home for any reason, the registration category will revert exclusively to Old Age. Chiswell Home is a care home providing personal care and accommodation for 6 older people. 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 DS0000019314.V260934.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Feedback from service users spoken to said that they were well looked after. Care plans were detailed but did not reflect the changing needs of the service users nor how their mental health needs were being met. The administration of medicines has improved but concerns remained as the home is still shortcutting the procedure in ordering of medicines. Following this inspection, the registered manager expressed her dissatisfaction and has contacted the inspectors and the CSCI regional pharmacy inspector to discuss this issue (although this requirement was initially made during his separate inspection and has not been complied with). The management of the home must be proactive rather than reactive. There has been several meetings with the registered manager and proprietor and the CSCI to identify a way forward to ensure that the National Minimum Standards are met. The registered manager had admitted service users with a diagnosis of mental health problems which the home was not registered for. In order to ensure that there were no further disruptions in the lives of the current service users, a variation was made in the registration category which allowed the service users to remain at the care home with the condition that all care staff were facilitated and provided with relevant certified training in mental health care. This would ensure that the mental health needs of the service users would be met. There were other areas for improvement particularly in relation to social and leisure activities, the furniture is old and worn which the home must address in order to meet the requirements of the national minimum standards. What the service does well: What has improved since the last inspection? The dining room was freshly painted and the lingering odour in bedroom 5 has been rectified. Chiswell Residential Home DS0000019314.V260934.R01.S.doc Version 5.0 Page 6 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.V260934.R01.S.doc Version 5.0 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.V260934.R01.S.doc Version 5.0 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 Adequate information was available to prospective service users and their relatives to assist them in their decision making process when chosing the home. 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. Service users who were able to communicate were complimentary of the service provision. There was evidence in the care plans scrutinised that a pre-admission assessment of needs of the service users were carried out either in their homes or places of residence. Chiswell Residential Home DS0000019314.V260934.R01.S.doc Version 5.0 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): 7,10 Care plans were reviewed regularly but did not reflect the changing needs of the service users. Records of medicines including the receipt, storage and disposal were kept in good order. However, there are still shortfalls in the procedures for dealing with these. EVIDENCE: Care plans had adequate information required by this Standard and were reviewed regularly but did not reflect the changing needs of the service users. One of the service users who had difficulties in swallowing had received guidelines from the hospital but there was no entry made in the care plan. It was also noted that service users with mental health problems did not have their mental health needs identified. 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. Chiswell Residential Home DS0000019314.V260934.R01.S.doc Version 5.0 Page 10 The home’s medicine policy and procedures still does not include that medicines must be retained for 7 days after the death of a service user. However, the home still 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. 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. Chiswell Residential Home DS0000019314.V260934.R01.S.doc Version 5.0 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): 12-15 The home promotes autonomy and choice. Visitors are welcomed and the home encourages integration with the local community in accordance with service users preferences. A programme of daily activities must be devised and implemented to ensure that service users have a choice in relation to social and leisure activities. EVIDENCE: The home provides limited activities for service users. On the day of the inspection the T.V in the lounge was broken and has been for a while. A small portable T.V was provided but the reception was poor. Staff on duty said that the T.V repair person had hurt his back. 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 DS0000019314.V260934.R01.S.doc Version 5.0 Page 12 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 The home has a complaints procedure. It was difficult to establish from the service users whether they were aware of this procedure. 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 DS0000019314.V260934.R01.S.doc Version 5.0 Page 13 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): 19,20,23,24,25,26 The home and its surroundings offer a comfortable and safe environment to its service users. However, the furniture in the lounge is in need of attention and or replacement. 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 repair the cracks in the wall of bedroom 4. EVIDENCE: The dining room wall has recently been painted. Most of the bedrooms were kept clean and contained service user’s personal furniture and belongings. However, there was cracks in the wall of bedroom 4 and the furniture in the lounge were old and shabby. 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 DS0000019314.V260934.R01.S.doc Version 5.0 Page 14 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): 27-30 The skills and experience of staff is varied. There was a dedicated and caring staff team who took great pride in the service provision. However, all care staff must be facilitated and provided with training in mental health to ensure that the current service users’ mental health needs are met. Staff files were not inspected on this occasion, as these were not accessible. 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 looked after’. Staff files were not inspected on this visit as these were not accessible. Currently, there are five service users who have a diagnosis of mental health problems. A variation to the registration was made to allow that these service users to remained at the care home. However, it is required that all care staff must be facilitated with a certified training in mental health to ensure that the service users needs were being met. Chiswell Residential Home DS0000019314.V260934.R01.S.doc Version 5.0 Page 15 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): 31,32,33,35,36,37,38 The management of the home remained reactive rather than proactive. The staff who have direct involvement with the service users appear to be dedicated to providing a good service. The registered manager must provide appropriate facilities for communication by facsimile transmission and must have a system for reviewing and improving the quality of care. She must also ensure that secure facilities are provided for the safe keeping of money and valuables on behalf of service users. The senior staff who are left in charge of the care home must be aware of the requirements of the Regulation 37 in order to notify the appropriate agencies when required. EVIDENCE: The management of the home have not been compliant in meeting fully the requirements and recommendations of the previous inspection reports. However, some requirements were complied with in relation to the last inspection report. Chiswell Residential Home DS0000019314.V260934.R01.S.doc Version 5.0 Page 16 The home still 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 service users money is still kept on the shelf in the kitchen. Discussion with the person in charge on the day of the inspection, transpired that she was not aware of Regulation 37 nor its requirements. 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 DS0000019314.V260934.R01.S.doc Version 5.0 Page 17 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 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 3 x x 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 1 3 1 3 3 1 Chiswell Residential Home DS0000019314.V260934.R01.S.doc Version 5.0 Page 18 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 OP7 Regulation 15 (2) (b) Requirement The registered manager must ensure that care plans must reflect the changing needs of the service user including those with mental health problems. The registered manager must ensure that a procedure is in place such that the staff have sight of the original signed prescription before it is dispensed and a copy retained. Outstanding from inspection of 02 12 04 The registered manager must ensure that the medicine policy and procedures must include that medicines must be retained for 7 days after the death of a service user. Outstanding from inspection of 02 12 04 The registered manager must ensure that equipment including T.V provided for use by service users is maintained in good working order. The registered manager shall make suitable arrangements to prevent and spread of infection DS0000019314.V260934.R01.S.doc Timescale for action 31/10/05 2 OP9 13 (2) 31/10/05 3 OP9 13 (2) 31/10/05 4 OP12 23 (2) (c) 31/10/05 5 OP26 13 (3) 31/10/05 Chiswell Residential Home Version 5.0 Page 19 6 7 8 OP19 OP19 OP29 23 (2) (b) 16 (2) (c) 17(2) &19(1)(b) 9 OP30 18 (1) (c) (i) 10 OP31 16 (2) (a) (ii) 11 OP33 21 (1) (a) (b) 12 OP35 16 (2) (l) 13 OP38 18 (c) (1) at the care home: a) By providing alternative hand drying facilities to that of terry towels. b) By providing liquid soap. Outstanding from inspection of 25 05 05 The registered manager must ensure that the cracks in the wall of bedroom 4 must be repaired. The registered manager must replace the old and shabby furniture in the lounge. The registered manager must ensure that all staff must have documents 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. Outstanding from inspection of 25 05 05 The registered manager must facilitate and provide training in mental health for all care staff to ensure that the mental health needs of the service users are met. The registered manager must provide appropriate facilities for communication by facsimile transmission. Outstanding from inspection of 25 05 05 The registered manager must ensure that a system for reviewing and improving the quality of care is established and maintained. Outstanding from inspection of 25 05 05 The registered manager must ensure that secure facilities are provided for the safe-keeping of money and valuables on behalf of the service users. The registered manager must ensure that staff left in charge of DS0000019314.V260934.R01.S.doc 30/11/05 30/11/05 31/10/05 30/11/05 30/11/05 30/11/05 31/10/05 31/10/05 Page 20 Chiswell Residential Home Version 5.0 the care home are aware of the requirements of the Regulation 37. 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.V260934.R01.S.doc Version 5.0 Page 21 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. 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