Inspection on 28/06/05 for Chiswick House

This inspection was carried out on 28th June 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chiswick House 19/03/09

Chiswick House 23/02/07

Chiswick House 24/01/06

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 Kim Patience Unannounced 28 June 2005 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. Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Chiswick House Address 3 Christchurch Road, Norwich, Norfolk, NR2 2AD 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) 01603 507111 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 I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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 25 January 2005 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. Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took approximately 4.25 hrs to complete. A notice of the inspection was posted in the foyer to alert people to the inspector’s presence and a number of service user and relative comment cards were left with the visitors book. During the inspection, a tour of the premises was conducted and staff and service users were spoken to. The medication arrangements in the home were inspected and records relating to staff and service users were reviewed. In May 2005 the shares in this home were bought by Black Swan International Ltd who have taken over the responsibility for the management of the home. The registered manager and staff team working in the home remain the same. What the service does well: What has improved since the last inspection? What they could do better: The medication arrangements in the home need to be improved to safeguard the residents from harm. The home needs to ensure that residents engage in aspects of daily living within a risk assessment framework. The management must ensure that recruitment practices are rigorous enough to protect vulnerable people. Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 6 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. Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 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 standard(s) 0 N/A EVIDENCE: N/A Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 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 standard(s) 7,8,9,10 Resident’s overall needs are assessed and recorded in an individual plan of care. However, the risks associated with daily living had not been adequately assessed. The home makes every effort to ensure that resident’s health care needs are met appropriately. The management cannot fully demonstrate that residents are protected by the medication arrangements in the home. The principles and values of the home aim to promote peoples rights. EVIDENCE: Service user records were inspected and were found to contain detailed information about the individuals needs. Care plans had been written in respect of personal care, social care and medical care that included preferences in relation to waking, bedtime routines, meals, bathing, activities and medical contacts. The care plans had been reviewed on a regular basis. Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 10 It was not clear whether residents had been involved in preparing the plans, as they had not been asked to sign in agreement. It is recommended that residents participate in the preparation of their care plans and are asked to sign to denote their involvement. See recommendations. The plans did not contain a picture of the resident as required in the standards. See requirements The plans contained a brief risk assessments in respect of daily living but these were not adequate and in one case a resident known to be at risk of falling did not have a risk assessment in this respect. See requirements. As previously mentioned, the residents plans contain details of medical contacts and records of any medical intervention are kept. The records showed the individuals medical history, any medication taken and appropriate contact with health professionals. Medication reviews had taken place on a regular basis and changes in medication were recorded appropriately. An inspection of the homes medication arrangements was conducted. A senior care worker with designated responsibility for the administration of medication was available to talk the inspector through the process. The home has a policy and procedure for the receipt, recording, storage, handling, safe administration and disposal of medication. A record of receipt and disposal of medicines is maintained and any entries are verified by the supplying pharmacy. Medicines were being stored appropriately in a lockable cupboard that contains a lockable facility for controlled drugs. A record of each individual’s medication requirements is kept, and updated regularly to reflect any changes. The list is kept on the residents care plan and in the medicine cupboard. The home was not able to show which staff had responsibility for the administration of medication as the manager did not maintain a list of named staff and sample signatures. The home was not able to show that staff with designated responsibility for the administration of medicines had received accredited training to do so. See requirements. When entering residents rooms prescribed external medicines were seen. All prescribed medicines should be appropriately stored in a lockable facility. The home does not have risk assessments in place for those people selfadministering medication. (This relates to external applications) Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 11 The home has a fridge for medicines requiring storage at lower temperatures. However, while the fridge had a lock fitted, it was not locked and the manager did not have a key. On inspection of resident’s medication administration records, it became apparent that one service user had not been given her medication at 8am that morning and the member of staff said it was an oversight on her part. Another resident had been given her medication but the records had not been signed to confirm this. There did not appear to be any issues with the procedure for the administration of medication that would have resulted in the oversight and it may have been as a result of staffing shortages due to sickness on the day. See requirements made in respect of the above medication issues. Resident’s rights are promoted within the home. Those people interviewed talked of staff showing awareness of their right to privacy and being respectful of their needs. The records relating to residents showed that peoples preferences in respect of daily living were noted. Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 12 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) 15 The home provides good quality meals presented in a way that is appealing to people living in the home in nice surroundings. EVIDENCE: In order to assess this standard the chef was interviewed, menus were inspected, meals were discussed with residents and the meal served on the day was observed. The menus are prepared by the chef and show a wide variety of meal choices. Each week the residents are given a copy of the menu to select their choices for the following week and these are recorded on the menus supplied. In addition, resident’s likes, dislikes and any special dietary requirements are recorded on the care plans. The menus offer a choice of two options for the main meal and for supper. Fresh fruit and vegetables are served on a daily basis and fresh meat is delivered to the home three times a week. Six residents have special dietary requirements, three of who need their food liquidised. Two of those residents were interviewed and spoke of being satisfied with the way their food was prepared and presented. One lady said Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 13 that the chef made great efforts to meet her requirements with carefully chosen foods that she could easily manage. Residents spoken to enjoyed the meals provided and thought they were well cooked and nicely presented, observation of the meal served during the inspection supported this view. People can take their meals in their own room, the conservatory or around a large table in the dining area. Menus are placed on the tables to remind people of what they may have chosen to eat on the day and to give them an option to change their mind if they wish to do so. Residents meetings are held and food/drink is an agenda item. Minutes of the last meeting were seen and it stated that residents were generally happy with the food served and were reminded that they could request changes to the menu at any time. In addition to consultation at meetings, residents are given the opportunity to complete a survey. The chef has completed a course in basic food hygiene. Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 14 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) 0 NA EVIDENCE: NA Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 15 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, 20,23,24,25 26 This home appears safe and well-maintained, however the management are unable to fully demonstrate their commitment to ensuring that this remains the case. The indoor and outdoor facilities are safe and comfortable. Resident’s rooms meet their needs and provide safe comfortable surroundings. The home is kept clean, tidy and hygienic. EVIDENCE: A tour of the premises was carried out and on the whole, the home is nicely decorated and furnished throughout. The manager was not aware of a plan of maintenance and renewal to show how standards would be maintained and it is recommended that the new company produce’s one in the near future. See recommendations Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 16 The home features a large lounge that contains a range of comfortable seating, a small table and chairs and a piano. The lounge contains a TV and radio in addition to books, games and videos used for entertainment. There are French doors leading to a pleasant landscaped garden. The home also has a conservatory, again with access to the garden and outdoor seating area. The conservatory is a very pleasant place to sit and popular with the residents. During the inspection a number of residents rooms were entered. Each was found to contain adequate furniture, suitable for purpose. The rooms were comfortable and personalised with people’s own pictures and belongings. The home was found to be generally clean and tidy and residents were happy with the standard of cleanliness in their rooms. Domestic staff are employed at the home and were observed during their cleaning routines. No offensive odours were detected in the home and bins were in place for the appropriate disposal of clinical waste. The requirement made at the last inspection to fit hot water regulator valves to the wash hand basins has not been met and is carried forward. See requirements. Not all the elements of these standards were assessed on this occasion. Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 17 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) 29 The management of this home is not able to demonstrate that recruitment procedures fully protect the safety and well-being of the residents. EVIDENCE: Staff files pertaining to three newly employed members of staff were inspected. An application form had been completed and individuals had been invited for a face-to-face interview. However, in all three cases it was found that employees had commenced prior to the completion of a POVA check or CRB. References had been taken up and in two cases, evidence of identification was found. The management must ensure that they are up to date with current requirements in respect of preemployment checks and correct record keeping. See requirements. Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 0 NA EVIDENCE: NA Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 19 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 N/A N/A N/A N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 N/A 13 N/A 14 N/A 15 4 COMPLAINTS AND PROTECTION 3 3 N/A N/A 3 3 2 N/A STAFFING Standard No Score 27 N/A 28 N/A 29 2 30 N/A MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 20 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 7 Regulation 17(1)(a) Requirement The registered person must ensure that service user records are kept in accordance with the requirements of schedule 3 The registered person must ensure that risk assessments in relation to falls and the selfadministration of medication are carried out. The registered person must fit hot water temperature regulators to wash basins in service users room. This requirement is made for the second time. The registered person must ensure that CRB and POVA checks are carried out prior to new staff commencing employment at the home. The registered person must ensure that the home has suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines.This relates to all the concerns raised in standard 9 The registered person must ensure that staff are provided with training that is appropriate to the work they are to perform. Timescale for action 31.08.05 2. 7 13(4)(c) 13.08.05 3. 24 23 31.08.05 4. 29 19 31.07.05 5. 9 13(2) 31.07.05 6. 30 18(c)(i) 31.07.05 Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 21 This relates to medication training. 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 7 19 Good Practice Recommendations It is recommended that service users sign their care plans to denote their involvement and agreement with what is written. It is recommended that the home has a plan of maintenance and renewal. Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF 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 Chiswick House I55 S27427 Chiswick House V235777 280605 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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