Inspection on 19/03/09 for Chiswick House

This inspection was carried out on 19th March 2009.

CSCI found this care home to be providing an Good service.

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

Chiswick House 23/02/07

Chiswick House 24/01/06

Chiswick House 28/06/05

Chiswick House 25/01/05

Chiswick House 01/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chiswick House 3 Christchurch Road Norwich Norfolk NR2 2AD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andy Green     Date: 1 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Chiswick House 3 Christchurch Road Norwich Norfolk NR2 2AD 01603507111 01603507111 HeadOffice@BlackSwan.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: EJP Interests Ltd care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May from time to time admit a maximum of one service user in the home between the age of 50 and 65 years. Date of last inspection Brief description of the care home Chiswick House is a large detached property situated adjacent to the centre of Norwich, and is within easy reach of the city centre. The home is set in its own grounds with well maintained gardens containing mature trees and flower beds. Externally the building appears to be in a good state of repair. The home has its own car park at the front of the home, and there is ramped access to the front door. The home can accommodate 20 elderly service users, one of whom can be under 65 years of age with a physical disability. There are 18 single room (two with en-suite) and one double room (en-suite) which is currently in single occupancy. The interior of the home is spacious and comfortable, and there is an air of tranquillity and calmness. The Care Homes for Older People Page 4 of 24 Over 65 20 0 Brief description of the care home conservatory has additional seating, and provides views out over a pleasant garden. The weekly cost of living in the home is £506.80. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We the Commission for Social Care Inspection undertook an unannounced inspection on 19th March 2009. We met with the manager, operational manager, care staff, a relative and residents to gather their views regarding the services offered in the home. A number of records were inspected including care plans, training records, staff files, medication records and health & safety records. A tour of the building and grounds was also undertaken. The home completed an Annual Quality Assurance Assessment which is a self audit document that gives the home an opportunity to assess how they are meeting standards and regulations. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides comprehensive information to residents and their relatives before they move in ensuring that they are aware of all the services provide. Evidence: The statement of purpose has been reviewed to include the care planning policy. No further changes have been made since the last inspection of the home. The manager stated that these documents are reviewed during the year to ensure that they remain up to date and accurately reflect the services that are provided. The manager and a senior carer undertake assessments to ensure that the home can meet the persons care and support needs. Evidence of a pre admission assessments were seen on care plans that were inspected. Prospective residents and their relatives can, where possible, make visits prior to admission to ensure that they can make an informed decision about whether they wish to live in the home. There have been no changes to the assessment procedure since the last inspection. Care Homes for Older People Page 9 of 24 Evidence: The home does not provide intermediate care. The manager liaises with health care professionals including district nurses and GPs. Aids and adaptations are in place to meet residents needs. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated with dignity and respect and receive personal care to meet their assessed needs. Evidence: Care plans give staff information to ensure they are able to provide appropriate care and support for residents. There is a front page with a photograph and a range of essential information including next of kin and important contacts. A brief social history is also included. The care plans are divided into individual risk assessments which are signed and agreed by the resident. Examples included; falls prevention, accessing the community, moving and handling, nutrition, personal care, challenging behaviour and the use of bedside rails. Risk assessments were easy to read and understand with clear aims and objectives. Daily care notes are kept detailing the care and support provided during the day and at nighttime. It was particularly helpful to see night reports written in red pen so that they could be clearly seen. Care Homes for Older People Page 11 of 24 Evidence: However it was noted that guidelines in care plans were somewhat brief and it is recommended that the home adopts a more person centred approach to care planning to give a more holistic approach. This was discussed with the manager who agreed to research ways in which care plans could be further developed. Goals for the service user and objectives to meet these goals were clear. Continence plan, pressure care, gender sensitivity issues, incidents and accidents and medication were included. Activity preferences are identified and recorded in the care plan. Health care and support from professionals including district nurses, community psychiatric nurses, GPs, continence advisors and chiropodists are separately recorded. The policy and procedures for the administration of medication was inspected and the recording was found to be accurate. The home has changed its pharmacy supplier since the last inspection and medication is now supplied in monitored dosage blister packs. The manager and senior staff monitor medication administration to ensure consistency. The operational also audits medication procedures as a part of the monthly management checks. Staff were observed interacting with residents in a friendly and professional manner that promoted privacy, dignity and choice. All of the residents spoken to said that staff were caring respectful and friendly. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to a variety of activities and well presented and varied menus. Evidence: There are a range of activities that residents can participate in if they wish to. The home has an art and poetry group and pictures are display board for an exhibition. There are paid entertainers who provide musical entertainment once a month. There is a video/dvd film afternoon and staff also help organise card games and armchair exercises. A lively card game was in progress which was being enjoyed by a number of residents in the lounge. Residents have the opportunity to attend church a number of residents will be going to a Mothers Day service at the local church. A priest also visits regularly.Residents occasionally go out to local pubs and theatre trips and garden parties are organised during the summer months. The local High School also regularly invite residents to their events throughout the year. A relative spoken with said she was always made welcome in the home and this was supported in the surveys received from relatives. Care Homes for Older People Page 13 of 24 Evidence: Residents can have cooked breakfast, served in their bedrooms if they wish. Snacks and drinks are made available throughout the day. Lunch was observed and there was a choice and the meals provided which were nutritious and appetising and well presented. Tables were laid with fresh flowers and napkins.There are regular residents meeting and menu preferences are discussed to ensure that choices are offered and that mealtimes in the home are an enjoyable activity for all. The cook also regularly talks to residents to ensure that the meals provided meet individual preferences and nutritional needs. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints and safeguarding processes to make sure that residents and their representatives are able to raise concerns and have them dealt with appropriately. Evidence: There have been no complaints recorded since the last inspection. Residents spoken to were quite clear that they would speak to the manager if they had any concerns and felt that the manager was approachable and easy to talk with. The home has a good relationship with relatives and ensure that concerns are dealt with in a timely and professional manner. The home has a safeguarding adults policy and staff spoken to were clear of their roles and responsibilities in this area. Staff receive annual safeguarding training. All were aware of the whistle blowing policy and would have no hesitation on reporting concern to the manager There are no ongoing complaints being investigated. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home provides residents with a safe, comfortable, clean place to live. Evidence: Chiswick House continues to be well maintained and provides attractive and spacious communal areas which are bright and airy with good views of the gardens. There has been a programme of refurbishment and redecoration since the last inspection including; a new shower room, new fire doors and the fitting of radiator covers. Residents bedrooms are redecorated on an ongoing basis and they are encouraged to personalise their rooms with personal possessions and furnishings. Residents and their relatives stated that they found the home to be always clean, fresh and comfortably presented. The home has a handy man who carries out minor repairs, redecoration and portable appliance testing (PAT test) The gardens are accessible and planted with trees shrubs and flowers and residents said that they enjoyed spending time in the gardens with their relatives during the summer months. Two new patio areas have been laid along with new paths and a gazebo. The manager stated that a number of residents had expressed an interest in Care Homes for Older People Page 16 of 24 Evidence: starting some gardening projects and plans are underway to develop this further. The laundry room remains in the cellar and this is not the ideal as the steep stairs could be a risk for staff. The provider plans to change the position of the laundry in the near future as part of a planned extension to the building. Residents do not have access to the laundry room The home was clean and tidy free from any offensive odours. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment policy and processes ensure that residents are protected from harm. Training is provided to make sure that care staff are competent to deliver personal care to the residents they support. Evidence: There were enough staff on duty at all times to meet the needs of residents with three staff in the morning and afternoon and two at night time. The manager is also available during the day and is clearly a hands on person rather than being only in the office. There are two cleaners during the week and a cook and handyman. Staff did say that more staff would be advantageous but felt that they could offer a good quality of care with the present staff numbers. The home has a staff training file which identifies the training that has been completed by staff and when updates/refreshers are required. Staff spoken with stated that they had received training in safeguarding adults, moving and handling, NVQ at levels two and three, fire safety, medication and infection control. Staff supervision has improved with at least six recorded sessions during the year. There are regular staff meetings and annual staff appraisals. Staff confirmed that they found the manager to be supportive and that they were provided with regular training throughout the year. The home now has 60 of staff trained to NVQ level two or three in the home. Care Homes for Older People Page 18 of 24 Evidence: The home ensures that recruitment checks are completed prior to the person commencing work in the home. Two staff files were seen and they contained evidence of appropriate checks. Recruitment documents eg references and application forms are held in the organisations personnel office and there is an agreement in place with the Commission that these documents can be readily made available upon request. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and the manager provides supportive leadership and guidance to staff. Evidence: Since the last inspection a new manager has been appointed who had previously held the deputy managers post in the home. She is in the process of registering on the Leadership Skills course and NVQ at level 4 four. All residents, relatives and staff spoken with were positive about her saying that she was both supportive and approachable. She is also in the process of registering with the Care Quality Commission. All staff complete training relating to health and safety and certificates for this training was seen in the training file and in individual staff files. One of the organisations operational manager continues to monitor the quality of the service and has a monthly audit that focusses on the national minimum standards. Care Homes for Older People Page 20 of 24 Evidence: Formal staff supervision has improved and is provided on a more regular basis. Health and safety checks are made and the required fire safety records, drills and risk assessment are accurately maintained. Water temperature checks are recorded and there are contracts in place for the regular testing of services and equipment in the home. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It is recommended that care plans are written in a more person centred style to give a broader picture of the resident and their needs. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!