Inspection on 17/08/06 for Chrislyn House

This inspection was carried out on 17th August 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chrislyn House 30/07/08

Chrislyn House 07/08/07

Chrislyn House 06/03/06

Chrislyn House 02/11/05

Chrislyn House 28/01/05

Chrislyn House 07/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Chrislyn House 14 Rosemary Road Clacton On Sea Essex CO15 1NX Lead Inspector Tim Thornton-Jones Key Unannounced Inspection 17th August 2006 10:00 Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 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 Chrislyn House DS0000017793.V309036.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 and Care Homes for Adults 18 – 65*. 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. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chrislyn House Address 14 Rosemary Road Clacton On Sea Essex CO15 1NX 01255 428301 01255 428301 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) Flat Mead Limited Mrs Karen E Stanton Care Home 26 Category(ies) of Learning disability (26), Learning disability over registration, with number 65 years of age (26) of places Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2006 Brief Description of the Service: Chrislyn House is a converted property, consisting of a main house and mews. It is situated in the centre of Clacton and has access to the facilities and services provided in the town, including the seafront, library, shops and cafes. The main building has accommodation for 22 service users, whilst the mews is intended for the use of four service users who are more independent. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based upon the first ‘Key’ Inspection of this service using revised ways of determining outcomes for service users. National Minimum Standards assessed were taken from both Adults’ and Older Peoples’ documents in view of the registration category for the service. The majority of service users are now over the age of 65 years, although the care and support required by the service is mainly in response to their learning disabilities and associated needs rather than the onset of older age. Several service users use the local community without the support of carers and are relatively independent, particularly those persons residing within the dwelling referred to as ‘The Mews’. The premises have been progressively improved in terms of facilities and the registered person stated that the decoration, furnishing and the programme of improvement would continue. The relationship between care staff and service users was observed to support a positive care outcome and this was acknowledged by both staff and service users. Staff supervision and training/development require development to meet the requirements of National Minimum Standards. The staff related standards were concluded as the weak area of the inspection outcomes. Questionnaires were sent to relatives and healthcare professionals by CSCI prior to this inspection. Of those that were returned, all expressed satisfaction with the service. The Manager, whilst very experienced and having undertaken some occupational day courses recently, remains in need of an appropriate qualification and no progress has been made to achieve this since the last inspection. Whilst a relatively low number of statutory records were viewed at this inspection all met the requirements of the Care Homes Regulations 2001. Some, but not all, of the key documents have been produced in easy read and picture assisted format. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: • There remain some areas of the house, mainly the upper floor, where continued improvements to the décor is needed. The registered person acknowledged this. Staff supervisory and training systems would benefit from improvement. Some essential policies, such as the complaint procedure, would benefit from easy read version. The Manager has not attended any recent training toward obtaining an appropriate qualification. • • • 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. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA1 & 2. OP1, 3 & 6 • • • Service users do not yet fully benefit from all of the information required to make informed choices or fully benefit from assessment activity. Service users benefit from terms and conditions arrangements. Service users do not fully benefit from satisfactory assessment practice. The outcome for this group is judged as ‘adequate’ in that strengths were found but there are areas of some weakness. Most key standards under this outcome heading are almost met. We judge that individuals are safe in how the service delivers this outcome area. EVIDENCE: Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 9 The service has developed a Statement of Purpose and Service Users Guide. The latter document is helpfully designed using various images to help individuals understand the document. It would be helpful to produce the Statement of Purpose in a similar manner or perhaps a service user version. A case tracking approach in relation to three service users showed that the Service Users Guide had not been issued to them individually. The Manager confirmed that whilst a document was available, no service user had received a document that contained individual information, although a separate terms and conditions document was available; this too had been produced in a helpful format. Discussion with the Manager regarding the use of these documents concluded that the Statement of Purpose should clearly state that some of the information required to be included within the Service Users Guide, such as the terms and conditions. The reasons given by the Manager were that this information includes the method and payment of fees incurred by the service user and it is considered this is confidential to the service user. The Registered Person will need to ensure, however, that all information that is required be included within the documents is available and specified as such within the Statement of Purpose. All service users, currently accommodated, have been living at the service for some time. One new admission had taken place since the previous inspection. The case tracking approach considered the practice associated with the admission and found that the statutory assessment prior to admission was not evident. The service admission procedure did highlight the main needs and aspirations of the person, and this included a medical condition. In tacking the pre-admission assessment information about this condition to the plan of care, it was noted that the plan did not take adequate account of this condition and that the healthcare plan did not identify in what way the home was intending to support the person in this regard. The care management approach should be reviewed to ensure that all identified care related matters at the point of or prior to admission are adequately translated onto the plan of care, with consent of the individual. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA6, 7 & 9. OP7, 14 & 33. • • Service users benefit from care planning arrangements although plans do not fully support individual choices and control. Service users are able to take risks and are adequately recorded. This outcome group has been judged as ‘good’ and has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key standards under this outcome heading are generally met, but there are some areas of improvement that the Commission are confident the provider can manage. EVIDENCE: Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 11 The outcome of case tracking showed that the care management arrangements were generally well organised. The records used for care planning were, overall, clear and reflective of a person centred approach, although the data held would benefit from some continuing development to ensure that the person centred approach is maintained. The care management for one service user recently admitted (resident for several weeks) needed to be more comprehensive to fully understand all of the care requirements being presented. Discussion with the relevant key worker indicated that there was a weak link between known practice and the strategy specified, where this was evident, within the care plan. In discussing with the keyworker two clear presenting care needs of the service user; one medical, the other behavioural, there was limited understanding of an agreed strategy or knowledge of the condition. There was evidence that the key worker was making a clear effort to assist the service user with these issues and that the difficulties were recognised although there was insufficient method and agreed outcomes detailed within the plan of care. The observed interactions between service users and carers were friendly and appropriate. Staff used appropriate tone, language and volume when communicating. There does remain some examples of staff using what could be perceived as rather patronising, inappropriate terms of reference such as ‘dear’, ‘lovey’ and similar. Based upon this visit, these remarks were attributed to a very small number of staff and it remained unclear as to whether the term of address was acceptable to the service users. The Manager will need to review this as part of a supervisory system. Service users spoken with expressed they were happy living at Chrislyn House and considered they had freedom to express their views and enjoyed good access to the community. One service user spoken with was working part time at a local Public House, with the support of the home. Two service users spoken with, who are in a relationship, regularly use the community and one stated they receive support from staff when needed to access services within the locality, such as the bank. Personal and healthcare aspects of the service are mainly in place although for one service user case tracked there was limited information and planning seen in relation to a medical condition, as previously highlighted. Subsequent discussion with the Manager indicated that arrangements were in place, although these were not fully evident. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA12, 13, 15, 16 & 17. OP10, 12, 13 & 15. • Service users benefit from being supported to engage with the local community and to find appropriate jobs, where applicable, and to access local facilities. DS0000017793.V309036.R01.S.doc Version 5.2 Page 13 Chrislyn House • • Service users benefit from a flexible service that encourages appropriate freedom of movement and ‘rules’ being kept to a minimum. Service users benefit from a good catering service. This outcome group has been judged as ‘good’ and has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key standards under this outcome heading are generally met but there are some areas of improvement that the Commission are confident the provider can manage. EVIDENCE: The location of the home is within central Clacton town centre and for this reason it is ideal for service users to access a variety of facilities. A significant proportion of service users have lived within the area for many years and are able to access services alone or with minimum help from carers. Such activity is encouraged by the home and of the case-tracking sample taken, there are some risk assessment documents relating to this. Service users commented that carers are kind and that they feel well supported. Service users are virtually all of retirement age and it is understood that none now attend occupation based day placements. Some, however, remain interested in attending a local drop in centre and do so on a regular basis. Overall, practice observed indicated that the regime did support individual rights. Some service users have chosen to lock their own rooms and retain the key, for example. Based upon a case-tracking sample, three service users stated that they enjoyed walking to the local shop, for example, to buy a newspaper and, with support, using the local community. It was stated by one service user that, having recently moved to the home, they were now settling and enjoying living in ‘the annex’, which gave more independence in a similar way to a previous living situation, but with more help. Another service user commented on the freedom enjoyed from attending a part time job nearby. The home has a policy on smoking and the activity is restricted to a room with an outside door for ventilation. During colder months it would be less feasible for service users to sit with the door open and therefore the registered person is recommended to investigate the fitting of air extraction to expel fumes. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 14 All service users spoken with stated they considered the food to be good and for the most part enjoyed the meals. The midday meal was noted to be appetising, of good quantity and well presented, although the meal was not subsequently observed being eaten by service users. None of the records seen indicated that the sample group needed to follow a special diet. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA18, 19 & 20. OP8, 9 & 10. • • • Service users benefit from receiving personal support in the way they prefer and require. Service users broadly benefit from the arrangements to meet their physical and emotional health needs. Service users benefit from the home’s arrangements to the management of prescribed medicines. This outcome group has been judged as ‘good’ and has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key standards under this outcome heading are generally met but there are some areas of improvement that the Commission are confident the provider can manage. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 16 EVIDENCE: The case tracking approach concluded that service users were consulted about their care although it was noted that in the instance of the service user recently admitted, the service had not confirmed in writing to the person that their needs could be met. The manager will need to rectify this. Service users stated that times for getting up and going to bed were flexible. The three service users presented as wearing clothes that were in keeping with their choice and appeared age and gender appropriate. None of the service users case tracked used aids and adaptations to assist with mobility. One service user accommodated did use a wheelchair to get around the home. One of the service users case tracked was receiving support from a community nurse in relation to underpinning mental health issues. The service user is to commence counselling in relation to a recent bereavement, as advised by the manager, although this was not detailed within the plan of care. The person’s presenting needs are evidently their learning disability rather than mental health and therefore the registration category remains appropriate. The registered person, however, is advised to undertake a general review of service users’ needs to ensure that all are, in fact, primarily those associated with a learning disability and not mental health. Where service users may present as needing more support with mental health issues it might be necessary to request a variation to the registration of the service. Visits by community nursing services and associated records were being maintained well. Each service user had a designated key worker and one such worker was spoken with. The role is operated at a rudimentary level at present and the inspection concluded that staff would benefit from additional training to ensure that all are fully understanding of the role and to integrate the actions into the day to day care of service users. The service holds prescribed medicines on behalf of service users, although there was no evidence on care plans confirming consent for this. The system used is of monitored dosage type, in ‘blister packs’. The senior carer on duty showed the inspector the practice and procedure used with the system. The system is secured in a room specifically for the purpose and the practice associated with its administration was good. The records were well maintained. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 17 Only senior carers who have received training undertake the tasks associated with prescribed medicines to ensure the safety of service users. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA22 & 23. OP16, 18 & 35. • Service users benefit from the home’s complaint procedure although do not yet fully benefit from the home’s procedure for safeguarding adults. This outcome group has been judged as ‘good’ and has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key standards under this outcome heading are generally met but there are some areas of improvement that the Commission are confident the provider can manage. EVIDENCE: The complaint procedure was evident and featured within the Service Users Guide, although as previously stated this had not been given to each service user. Based upon the case tracked sample, all three service users stated they felt confident to make a complaint if they felt they needed to. The Manager stated that the home had not investigated any formal complaint during the period since the previous inspection. CSCI had not received any complaints about the service during the same period. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 19 The overall approach to safeguarding adults appeared satisfactory in that an example was on file associated with one of the service users who was subject to case tracking. The matter appeared to have been managed in a satisfactory way involving a multi-agency approach although it is noted that CSCI was not notified as required by regulation 37 of the Care Homes Regulations 2001. From this perspective the home’s approach did not meet good practice requirements. The Manager stated that the revised policy and guidance had been received from the local authority and was available for inspection. The registered person will need to review the procedures of the home to ensure that the service practice links with the local authority and that all statutory agencies are notified as appropriate. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 24 & 30. OP 19 & 26. • • Service users continue to benefit from an improving environment. Service users benefit from a clean and hygienic environment. This outcome group has been judged as ‘good’ and has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key standards under this outcome heading are generally met but there are some areas of improvement that the Commission are confident the provider can manage. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 21 EVIDENCE: All of the communal areas and facilities of the home were visited and found to be clean and hygienic with no unpleasant odours noted. Various improvements to the environment have been made since the previous inspection, including the refurbishment and decoration of the dining room. This now features a new floor, decoration, furniture and revised lighting. New wall pictures complete what was considered to be a contemporary and comfortable modern room. A staff call system is currently being installed and is due to be operational shortly. Some service users have private access to their own rooms via a key. Two bedrooms were visited on this occasion and were found to be clean, well decorated and reflective of the occupant’s personality and interests. As previously stated within this report, one service user requires a wheelchair for mobility due to progressing age related immobility. The service user in question was observed attempting to pass through a doorway leading to the ‘smoking’ room, which was evidently very difficult due to the width of the doorway. The manager has widened some doorways and more are to be widened as the building improvement programme progresses. However, this is a difficulty for this particular service user and in view of the increasing age of the service user group, is likely to be an increasing feature. The Registered Person will need to review the building programme to ensure that the priorities are adequate and appropriate. Furniture and fittings within the communal areas are now of mixed quality upon reflection of the recently refurbished rooms, although are serviceable. Some areas of the premises, particularly the upper floors are in need of redecoration. It is accepted that these areas are due for improvement and are included within the current plan by the home. Service users spoken with stated they had no problems with the home in terms of the environment. The laundry area was adequate and washing equipment was capable of a high temperature wash cycle. The management of soiled laundry was satisfactory. Arrangements for the laundering of clothes and bedclothes etc were also satisfactory. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 32, 33, 34 & 35. OP27, 28, 29 & 30. • • • • Service users do not fully benefit from qualified staff. Service users benefit from staff that have been recruited in accordance with regulatory requirements. Service users do not benefit from staff numbers that have been set to reflect their needs and aspirations. Service users benefit from staff who have received some training provided by the home but the training requirements are not fully coordinated and therefore reduce the benefit to service users. The outcome for this group is judged as ‘adequate’ in that strengths were found but there are areas of some weakness. Most key standards under this Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 23 outcome heading are almost met. We judge that individuals are safe in how the service delivers this outcome area. EVIDENCE: Staff recruitment practices were reviewed by speaking with staff and viewing a sample of files. Recruitment procedures comply with requirements and there was adequate evidence available to demonstrate this. The Manager is operating an annual appraisal system that is quite comprehensive, although the ongoing supervision remains an open door, informal approach. Some formal supervision has commenced and where this was evident, the practice was developing although not fully adequate. The inspection observed that the relationship between staff and the manager was good. The registered person will need to review the homes practice and policy regarding supervision to ensure that it reflects sound practice and meets with the content and frequency stated within National Minimum Standards. Whilst the previous inspection examined standards associated with the training and competence of the workforce, this inspection concluded that the arrangements had not developed to reflect satisfactory standards. Of the staff files examined all had a list of training attended but no training plan for each individual or the service as a whole. One staff member spoken with had completed NVQ level 2 and was progressing with level 3, which is positive but not typical of the workforce. The Manager will need to structure the staff training and development approach to ensure that training needs are adequately identified and planned for. At the time of this inspection the service was unable to evidence how the current staff/service user ratio had been calculated. This is a matter that is required by National Minimum Standards and must be monitored to ensure that, as far as practicable, service users are adequately supported by adequate numbers of staff. The Manager confirmed that it is normal practice for the service to use a calculation recommended by the Department of Health. The system was available for inspection. The Manager stated that the calculation would be used to check on staff deployment. From an observational perspective the inspection did not identify any obvious shortfall in staffing numbers on the day of inspection in relation to the service users at home. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA37, 39, 41 & 42. OP31, 33, 35 & 38. • • Service users do not benefit from the home’s approach to quality monitoring. Service users benefit from the arrangements in place for their health and welfare. DS0000017793.V309036.R01.S.doc Version 5.2 Page 25 Chrislyn House • • Service users do not yet fully benefit from a home that is managed by a qualified person. Service users benefit from the home’s record keeping. The outcome for this group is judged as ‘adequate’ in that strengths were found but there are areas of some weakness. Most key standards under this outcome heading are almost met. We judge that individuals are safe in how the service delivers this outcome area. EVIDENCE: The Manager is also a Director of the responsible organisation ‘Flatmead Ltd’. Mrs Stanton has several years experience in the management of the home and has undertaken various training to assist her in the day to day operation of the service. Mrs Stanton has yet to progress for herself the required training that would lead to an NVQ in care and Management to level 4 or equivalent. This is now overdue, and for this reason National Minimum Standard 37 is not fully met. The quality assurance and monitoring approach by the home is in need of development. Whilst some planned improvements were evident there was no evidence of a formal annual development plan. The service does not have an approach within the home that can evidence a consultation with service users and stakeholders in a way that identifies the strengths and requirements of the service and to generate a clear plan of action. To the home’s credit, improvements have been made to various aspects of the home such as décor and some management systems although these improvements appear to be driven mainly by observed and experiential triggers rather than as a planned development based upon identified quality outcomes or service indicators. Various records were examined throughout this inspection. The following were found to meet with requirements. • • • • • • • • Staff Roster Record of whether the roster was actually worked. Record of food served. Complaint procedure. Accident Procedure. Staff records. Statement of Purpose. Service Users Guide. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 26 The Manager had monitoring systems for health and safety related requirements including fire safety and hazardous chemicals. Periodical checks in relation to these, including electrical safety were found to be up to date. The management of the service, overall, has a good outcome although this is mainly achieved by the intuitive knowledge and understanding that comes from a long standing relationship between service users and key staff, including the Manager. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 2 40 X 41 3 42 3 43 X 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Chrislyn House Score 3 2 3 X DS0000017793.V309036.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 YA36 Regulation 18(2) Requirement The Registered Person must ensure that all staff receives adequate and appropriate supervision at regular intervals. This is a repeat requirement. The Registered Person must ensure that the workforce are trained to ensure they are skilled and knowledgeable as to how to deliver appropriate support to service users. This is a repeat requirement. The Registered Person must ensure that each service user is provided with a Service Users Guide. The Registered Person must ensure that service users healthcare needs are assessed and appropriate arrangements are in place to meet them. The Registered Person must ensure that safeguarding adults policy and procedures ensure that the service user is folly protected by reporting concerns to all appropriate agencies. DS0000017793.V309036.R01.S.doc Timescale for action 02/10/06 2. YA32 18 02/10/06 3. YA1 4,5 02/10/06 4 YA19 12, 13 02/10/06 5 YA23 13 02/10/06 Chrislyn House Version 5.2 Page 29 6 YA33 18 7 YA35 18 8 YA36 18 9 YA39 24 10 YA37 9 The Registered Person must ensure that the home has an effective staff team with sufficient numbers and complimentary skills to support service users needs at all times. The Registered Person must ensure that there is a staff training and development programme that meets the changing needs of service users. The Registered Person must ensure that staff receive support and supervision they need to carry out their jobs. The Registered Person must ensure that quality assurance and quality monitoring systems are in place to measure the success in achieving the aims and objectives and statement of purpose of the home. The Registered Person must ensure that the Manager receives appropriate training associated with the management of a registered care home. 02/10/06 02/10/06 02/10/06 02/10/06 02/10/06 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 Refer to Standard YA16 Good Practice Recommendations The Registered Person is recommended to review the air extraction within the designated smoking area to protect service users from the effects of passive intake of tobacco fumes. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Chrislyn House DS0000017793.V309036.R01.S.doc Version 5.2 Page 31 - 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!