Inspection on 23/02/07 for Chiswick House

This inspection was carried out on 23rd February 2007.

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

Chiswick House 19/03/09

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Chiswick House 3 Christchurch Road Norwich Norfolk NR2 2AD Lead Inspector Ann Catterick Unannounced Inspection 23rd February 2007 09:00 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 Chiswick House DS0000027427.V331487.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. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chiswick House Address 3 Christchurch Road Norwich Norfolk NR2 2AD 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) 01603 507111 01603 507111 HeadOffice@BlackSwan.co.uk EJP Interests Ltd Mrs Carolyn Doyle Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May from time to time admit a maximum of one service user in the home between the age of 50 and 65 years. 24th January 2006 Date of last inspection Brief Description of the Service: 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 conservatory has additional seating, and provides views out over a pleasant garden. The weekly cost of living in the home is £472.00. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was an unannounced key inspection that took place on the 23rd February 2007 and was for a period of 7.5hrs. Prior to the visit to the home the Commission received the Pre Inspection Questionnaire and 15 comment cards, four from professionals, five from relatives and six from service users. The overall flavour of the comments made in comment cards were positive with the quality of care provided within the home as good. On the day of inspection the inspector was able to meet with service users, staff, the manager and proprietors as well as have a tour of the building and inspect care plans, staff files and other relevant documentation. The outcome of the inspection concluded that the home offers a very good quality of care in a comfortable environment with independence, dignity and choice be promoted and protected. Comments made by service users “Never had anything to complain about; the food here is wonderful.” “Staff sincerely want to look after you.” “Had a residents meeting last week.” Comments made by staff “Would be happy for my nearest and dearest to live here.” “Everyone is friendly and very caring.” “More like a family than a home.” “Visitors come and are made welcome and can stay for lunch.” “There are enough staff on duty but not too much opportunity to sit and talk to service users.” Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are able to have information about the home, prior to admission, to enable them to make a decision on whether or not the home would meet their needs and preferences. The assessment prior to admission ensures that nobody is admitted to the home unless their identified needs can be met. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 10 EVIDENCE: The homes brochure was seen and this was user friendly, written in plain English and gave prospective service users all the information that they needed to know about the home. Several care plans were seen and evidence of a pre admission assessment was seen on file. The pre admission assessment is comprehensive and all of those service users seen on the day of inspection appeared to be having their needs met. The home does not offer intermediate care. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each service user has a comprehensive care plan that provides all of the information needed to ensure that their needs have been identified and will be met. Service users dignity and privacy is promoted enable service user to be cared for in a way that is respectful and meets their needs. Generally the policy and procedures for the care and administration of medication is safe and promotes the safety of service users. There was one area of the process that needed to be improved. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 12 EVIDENCE: The format for care plans is good and gives the reader all of the information they need to be able to care for the service user. There is a front page with a photograph and all of the general information you would need to know about the service user including weight and wellbeing on admission. A brief social history is also included. Risk assessments are part of the care plan and these were clear and easy to read and understand with clear aims and objectives. Goals for the service user and objectives to meet these goals were clear. Continence plan, gender sensitivity issues, incidents and accidents and medication were all included. Activity preferences are identified and recorded in the care plan. The policy and procedures around caring for and administrating medication was inspected and in most areas good practice was evidenced. The documentation with regard the receipt of medication was, in some areas, unclear and it was difficult to track medication back to receipt. The recording in this area needs to be made clear so that the manager can audit the medication that is in the home. A requirement has been made in this area. Staff were observed interacting with service users and this was done in a way that promoted privacy, respected dignity and offered choice. A good example was when a service user was taken to the dining table in a wheelchair and was asked whether or not she wished to have her meal whilst sitting in the wheelchair or whether she would prefer to sit in a dining chair. Another example was when another service user became unsteady on her feet and the carer, very subtly asked for the support and a wheelchair of another carer without any other service user knowing there was any problem. All service users spoken to said that staff were respectful and protected their dignity. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are very satisfied with the occupation and stimulation that happens within the home and are able to pursue interests and preferences they had prior to admission and/or to develop new interests. Service users spoken to felt they had control over their own lives. Relatives and friends are always made welcome in the home. Mealtimes are a positive experience for service users with the food being nutritious and well presented eaten in pleasant surroundings. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 14 EVIDENCE: Each day there are specific activities that service users can participate in if they would like to. The home has an art group and pictures are mounted and put on a display board for an exhibition. One service user was proud to show the pictures created by himself and other service users. On the day of inspection a poetry session was taking place with a service user initiating this by selecting a particular poem and then discussing it origin and reading it to other service users. Service users spoke of residents meetings and how preferences and interests can be expressed in this forum. Service users said that visitors were always made welcome in the home and this was supported in the comment card received from relatives and friends. Service users were observed to have control on how they spent their day and person centred care was observed. An example of this was that a service user said that supper drinks were offered at 8pm. The service user enjoyed staying up late and had her supper drink at 10pm as this was her choice. One service user has chosen to self medicate and risk assessment and clear care planning have enable this to take place. Lunch was observed and on the day of inspection there was a choice and the meals provided were nutritious and appetising being well presented. Plates were warmed and the tables well laid with fresh flowers and napkins. Following a residents meeting more hot choices have been offered at teatime. Service users said that they had wine with their Sunday lunch and on the day of inspection sherry was had before lunch to celebrate a service users birthday. Mealtimes in the home are an enjoyable activity for all. Comments from service users: “Chef makes marvellous puddings.” “Very good sauces.” “Had residents meeting last week.” “Director chairs the meeting and listens to what you say.” Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive complaints procedure and information about this is issued to service users and their families to enable them to make complaints if they wish to do so. The home has a policy to ensure that the safety of service users is protected and promoted. EVIDENCE: There have been no complaints recorded since the last inspection. All service users spoken to were quite clear that they would speak to the manager if they had any concerns. They all felt that the manager was approachable and easy to talk with. The home has an adult protection policy and staff spoken to were clear of their roles and responsibilities in this area. All were aware of the whistleblowing policy and would have no hesitation on reporting concern to the manager or when appropriate the CSCI. The home had dealt with an issue within the home and followed all appropriate procedures. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 16 Comment form service user: “Would always speak to the manager if I had any concerns.” “I have never had to make a complaint” Comments made by staff “I would always speak to the manager about any concern I had.” “Would always whistleblow if I had any concerns. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have a comfortable and safe environment in which to live that enhances their experience of living in the home. The home is clean and well maintained. EVIDENCE: Chiswick House is a large detached property that is well maintained. The annual development programme for the coming year was seen and this identified areas for redecoration and refurbishment. There were also plans to ensure that all bedroom doors had a lock. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 18 The home offers attractive and spacious communal areas that are bright and airy with good views of the gardens. The gardens are very pleasant with trees shrubs and flowers and service users said that much time was spent in the gardens in the summer months. Bird tables and a dove house were pleasant distractions for service users. Not all radiators are covered and risk assessments have been made. Those radiators in bathrooms and toilets could be a significant risk to service users and a requirement has been made in this area. The laundry room is in the cellar and this is not the ideal as service users could not choose to have access and the steep stairs could be a risk for staff. The proprietor plans to change the position of the laundry at some time in the near future. The home was clean and tidy free from any offensive odours. Comments by service users “The gardens are lovely in the summer.” “”I like my room.” Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff working in the home who have the skills and experience needed to ensure that the needs of service users are met. The recruitment and selection process in the home is thorough and aims to ensure that service users are in safe hands at all times. Staff are well trained and this ensures that service users are well cared for in a way that best meets their needs. EVIDENCE: Staff and service users felt that there were enough staff on duty at all times to meet the needs of service users. Staff did say that more staff would be good but felt that they could offer a good quality of care with the present staff numbers. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 20 The home has a staff training file that identifies the training completed by staff and what training needs to be completed or updated. This was seen as good practice. Staff spoken with described the manager as supportive and said they were offered plenty of training. Staff meetings and supervision took place although supervision could be on a more regular basis. A recommendation has been made in this area. There is only 25 of staff who have NVQ level 2 or above and it is required that the home has at least 50 of staff with this training. A recommendation has been made in this area. Some comments from service users: “Staff sincerely want to look after you.” “Never heard staff grumble.” “Staff will do what they can if possible.” Some comments from staff: “By far the best home I have worked in.” “Good staff team.” “Always training available.” “More like a family than a home.” Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by an experienced manager and this ensures that the quality of care provided in the home is good. The home has a system to check the quality of the service it provides and this encourages continual improvement and ensure good practice is maintained. The systems in place around service users “looked after” money ensure safe practice in this area. The practice and procedures in the home aim to promote safe practice enabling service users to be cared for by experienced staff in a safe and comfortable environment. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 22 EVIDENCE: The manager is in the process of completing her Registered Manager Award and hopes to finish this later in the year. She has managed the home for five years and is experienced and competent in her role. All service users and staff spoke positively about her saying that she was supportive and approachable. 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. The home monitors the quality of the service and has a monthly audit focussing on the national minimum standards. The Proprietors are in the home on a regular basis and complete regulation 26 reports. Formal supervision does take place although this would benefit by being on a more regular basis. A spot check was made on the resident’s money that is ‘looked after’. The receipt and records were all in good order offering clear information about any financial deposits or withdrawals. The home now has all of the information required within standards 38. Incident and accidents are appropriately recorded. All staff receive induction training. Comments from staff “Supportive manager.” “Lots of training.” “By far the best home I have worked in.” Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 23 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 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x x x 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13.2 Requirement Timescale for action 01/04/07 2. OP25 13.4 The registered person must ensure that all recording of medication received is recorded and is accurate. The registered person must 01/05/07 ensure that all radiators that service users have access to are risk assessed and those radiators in bathrooms and toilets are covered or are of low temperature. 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 Refer to Standard OP28 OP36 Good Practice Recommendations It would be good practice to encourage as many staff as possible to complete NVQ level 2. It would be good practice to ensure that formal supervision takes place on a regular basis. Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Chiswick House DS0000027427.V331487.R01.S.doc Version 5.2 Page 26 - 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!