Inspection on 30/07/08 for Chrislyn House

This inspection was carried out on 30th July 2008.

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

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chrislyn House 07/08/07

Chrislyn House 17/08/06

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 13/03/2009.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Chrislyn House 14 Rosemary Road Clacton On Sea Essex CO15 1NX Lead Inspector Helen Laker Unannounced Inspection 30th July 2008 10:00 Chrislyn House DS0000017793.V366126.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.V366126.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.V366126.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 F/P 01255 428301 chrislynhouse1@aol.com 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.V366126.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2007 Brief Description of the Service: Chrislyn House is a converted property, consisting of a main house and adjoining 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. Currently the main building has accommodation for 22 residents, whilst the mews is intended for the use of 4 residents who are more independent. The proprietor advises us that because of the refurbishment and works being undertaken in the main building there is an intention to reduce overall numbers to 19 residents, and 3 residents in the mews as one resident has what was a double room but it is currently being used as a single. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out as part of the annual inspection programme for this home. The registered manager and proprietor were available on the day and assisted with the inspection process. The inspection focused upon all of the key standards. A full tour of the premises was undertaken. Evidence was also taken from the Annual Quality Assurance Assessment (AQAA) completed by the management of the home and submitted to the CSCI. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some improvement be noted as this contributes to the inspection process and indicates the home’s understanding of current requirements, legislation changes and own audited compliance. This document will be referred to as the AQAA throughout the report. Four residents and five staff were spoken with during the inspection. The CSCI sent feedback/comment surveys to the home for both residents and relatives for completion prior to the inspection. Three have been received from staff, three from relatives and ten from service users and the comments taken into account in the body of this report. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as staff rotas, care plans and staff files. Observations of how members of staff interact and communicate with people living there have also been taken into account. On the day the inspector visited the home, the atmosphere in the home was generally relaxed and welcoming and the inspector was given assistance from all staff on duty. At this inspection the home was accommodating 17 residents, and had 5 vacancies. 9 residents were away on holiday on the day of inspection. What the service does well: The service continues to develop the environment to a very good standard. Carers were seen to go about their tasks in a friendly, polite and helpful manner and this indicated there was a relaxed, caring and supportive environment. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 6 Residents spoken with were content, confident and relaxed and this reflects the ethos and management approach of the service. Comments from surveys included “When I visit I am impressed with the state of the furnishings and cleanliness” and “There is such a wonderful friendly atmosphere when you visit. The staff are cheerful and residents happy” What has improved since the last inspection? 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. Chrislyn House DS0000017793.V366126.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.V366126.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are supported by the transition arrangements for admission into the home and generally can be confident they will have made available to them the information they need to enable them to make a positive choice about where they wish to live. EVIDENCE: The Statement of Purpose remains unchanged since the previous inspection and the Service Users Guide is now available in the reception area but there was still no evidence to indicate that people at the home have a copy of the document themselves. Both documents have been reviewed at previous Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 9 inspections and found to meet regulatory requirements. Service users spoken to were unclear as to what a statement of purpose or service users guide was, however one relative who had not actually had sight of the document before stated “This home meets all my relatives needs anyway”. It is recognised that because of some service users disabilities they may have difficulties understanding this document fully. The proprietor stated, “As the building is being updated these documents are due for a review”. The AQAA states, “We provide a service that promotes independence, encourages individuality and ensures that the S/U is at the centre of everything we do.” Out of four service user files reviewed, all but one had a signed and dated contract and this indicated the fees payable each week, methods of payment and the terms and conditions of residence. These documents were not part of the Service Users Guide and were kept separately in a locked cabinet, as the information contained within the contract was considered confidential. At the time of the inspection only one person had been admitted to the home since the previous inspection and although an emergency admission appropriately completed pre admission documentation was seen. An admission policy and procedure was available to review on this occasion and was satisfactory. Feedback from relatives indicated that pre admission visits were undertaken and one survey stated “They had a warm and welcoming introduction to the home” The evidence available to ascertain the current practice of the home in admission procedures was found to meet National Minimum Standards. At this inspection the home had five vacancies. Chrislyn House DS0000017793.V366126.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be supported by their care plan arrangements because they are consulted about the things that affect their lives. Residents are not always protected by the arrangements for the assessment of risk. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 11 EVIDENCE: Four service users files were examined on a case-tracking basis. The care records indicated a comprehensive set of care decision sheets that included care outcomes and methods for the way carers should support the person. The local authority had undertaken annual reviews and care plans are reviewed routinely every three months. There was evidence to indicate that the person using the service was part of the decision making process and was present at reviews. Notes of the meeting indicated the person had signed their name and the decisions where appropriate. The care plans were to be in two parts. One part contains assessment data and care plan decisions that are chiefly needs lead, periodic reviews and records etc. The second part is a ‘Person Centred Plan’ (PCP), the documentation is more service user focussed in its layout and the language used is appropriate. The decisions in this part of the plan are mainly long-term outcomes and describe the service users aims and wishes. The PCP document is user friendly and is used in accordance with current thinking and empowering people to take more control of their lives and the decisions to be made. The Manager advised us that although the care plans are in separate parts the staff understand them and they are workable and understandable documents. The AQAA confirms that “We provide a service that promotes independence, encourages individuality and ensures that the service users are at the centre of everything we do, one example of this is those who are able, are supported to write their weekly shopping list and do their own shopping, demonstrating their control over their finances”. The care plan pathway overall has all the required elements of assessment, decision-making, monitoring and review. Reviews are undertaken 3 monthly and involvement directly with the service user in all plans except one, was not evident. A monitoring visit from the local authority on the 18th July 2008 also highlighted this. Whilst the structure of the care plans was similar, the individual plans seen were consistent with the needs of the person for whom they were intended. The daily recordings were clear overall and from the sample taken indicated that daily narratives were more outcome focussed and made improved links to decision making. All of the plans reviewed made reference to service user choice regarding bathing, choice of clothes or visits out etc. One service user stated “I don’t always want a bath in the morning and they help me whenever they can” In one sample care plan however it was clear that an independent advocate had been involved in the care planning process with the person and a pre-review ‘progress report’ had been completed by the person indicating active involvement in the care planning process and that an independent supporter had been involved to support the person. This should be consistent with all service users where capabilities allow. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 12 In discussion with people living at the home it was evident that the level of support and risk taking is proportionate to the capacity of the individual and this is achieved by a combination of formal risk assessment and intuitive judgement based upon knowledge and understanding of the person. One example was evidenced with regard to trips out and ensuring safety checks are made. The extent of the primary risk assessment by the staff member was suitable to ascertain whether the person was likely to be at known risk. This was not evident however in the case of 4 smokers where risk assessment had not taken place. The home has a policy on smoking and the activity is restricted to a room with an outside door for ventilation. The risk assessment framework within the service must have the capability of periodically testing the capacity of the person as their needs change and that any risk factors are incorporated within the plan. The care planning arrangements seen support the view that this is generally undertaken at the time of a 3 monthly review, however the manager will need to ensure that the system being used has the capacity to change a risk rating at any time to reflect changing circumstances. The proprietor stated in response to this that there are plans to review care plans monthly now and that in house care plan training is to have a more formalised structure to ensure consistency. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12. 13, 15, 16 and 17 Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 14 Residents can experience a relaxed environment and feel their rights are respected and recognised in their daily lives. The catering arrangements mean that residents can expect to receive an adequate range of food at times to suit their lifestyle and can expect to be supported by the staff team to maintain family links, friendships and access the community. 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 within the town including seasonal entertainment, day drop in centres and general shopping. 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 to maintain independent lifestyles and to reflect the principles of an ‘ordinary life’. Service users commented that carers are kind and that they feel well supported. The interaction between those who live and work at the home was friendly and supportive. An example of this was when one service user became upset due to a relative being unwell, consistent reassurance and support was given to them to ensure a degree of understanding was clear and visits were offered so that they did not remain so upset. Another example was that of a service user who had missed a top button on her dress and the staff member respectfully asked her whether she would mind them doing it up for them. Service users are increasing in age and it is understood that none now attend occupation based day placements, as most are post retirement age. Some however attend day centres and one person has a part time job. Overall, practice observed indicated that the regime supported individual rights. Some service users have chosen to lock their own rooms and retain the key, for example. Of the people spoken with few were sufficiently confident to use the local community without support although some do use the town by walking to the local shop, for example, to buy a newspaper. Information obtained from records and by discussion with people indicated that various indoor activities were available. A theatre production company visits, a magician, coffee mornings and annual tinsel and turkey visit is planned. At the time of this inspection 9 service users were on a weeks holiday with staff members at Gunter Hall. Few people at the home have relatives although those that do are in regular contact with them and this is encouraged by the home. Service users who Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 15 have experienced bereavement have had counselling arranged to assist with their losses. All service users spoken with stated they considered the food to be good and for the most part enjoyed the meals. Service users are given a choice and one service user who refuses to eat anything other than chicken, green beans and potatoes is accommodated adequately even on holiday this is pre arranged for them. The menu was varied and food stock is delivered two weekly although some items such as meat are purchased locally. The daily record of food served is still not adequately detailed to ensure that a suitable record is kept. It is recommended that the recording format be amended to improve the scope of recording. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Residents can expect good support and assistance with health and personal care enabling appropriate consultation and respect of individual choice. EVIDENCE: Files examined showed that consent for the home to administer medicines was in place, and we were advised that no one self-administers medication. Healthcare monitoring was well organised and a clear chronology of information has been compiled regarding medical and primary healthcare services. These included Optician, Dentist and GP etc. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 17 Some very positive and supportive work has been undertaken previously to assist a person who needed to have an operation and who has a fear of hospitals. Close work was undertaken which included gradual visits to the hospital to have refreshments in the cafeteria and building upon this to meeting nurses and gradually enabling the person to be less anxious. The medicines were a monitored dosage type and were being well managed and securely held. The administration records were overall accurately completed using the carer’s signature or a code designed to be used with the medicine administration form, called a ‘system code’. as appropriate. Information about the side effects of medicines being taken was held within the plan of care. Only senior carers who have received training undertake the tasks associated with prescribed medicines to ensure the safety of service users. It was noted that where transcribed medications have been documented, two signatures were not in place to ensure safety in checking procedures. There are no controlled drugs in use at present, but current storage does not meet the requirements for storage of controlled drugs should any be prescribed. The senior staff present at the inspection were informed of the current legislation surrounding this and were asked to provide a metal cupboard as the Royal Pharmaceutical Society Guidelines advise without further delay. The personal support provided was appropriate and consultative in approach. Carers were seen to knock on bedroom doors before entering and conversations between carers and people living at the home were relaxed and informal but appropriately respectful. In speaking to people all were confident and at ease in their surroundings. One service user said, “Well it’s not home but it’s close” Some of the carers had been working at the home some years and have built up positive friendly and supportive relationships. One staff member interviewed stated, “It is a home from home and before I came here I used to chat to the service users who sat out side the home. That prompted me to apply for a job here! I really get on well with the residents.” One relative survey stated “My relative can’t read or write and they find time to write letters for him” Another stated, “I think they make the residents feel special!” Chrislyn House DS0000017793.V366126.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome are is adequate. This judgement has been made using available evidence including a visit to this service. Residents can feel confident about how to complain and can expect to be listened to and their complaints acted upon. Residents cannot always be assured that all carers are adequately trained to safeguard their welfare. EVIDENCE: The proprietor stated that the home had not investigated any formal complaints during the period since the previous inspection. The AQAA confirms this and the CSCI has not received any concerns about the service during the same period. The complaint procedure remains unchanged, and has not been amended since the last inspection. The home has the current safeguarding adult’s policy and procedure provided by the local authority. A whistle blowing procedure was located within the policies and procedures file within the office. It was previously recommended that this procedure be given to each carer as part of the induction process to ensure that each person is able to access the information without the need to Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 19 access the main office, which is sometimes locked. A copy is to be located in the foyer area and we are advised that all staff have copies. All but four carers have received training in protecting vulnerable adults. The home has a distance learning pack but this has not yet commenced and evidence was seen that the Skills for Care training is to be introduced. Not all staff spoken to could confirm that they had undertaken POVA training or had a full understanding of whistle blowing procedures. This indicates that a more formal approach to training upon appointment of staff should be given more prominence. Chrislyn House DS0000017793.V366126.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28 and 30 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Residents can expect the communal areas of the home and bedrooms to be of a good quality standard and to live in a clean and safe environment overall. Residents are assured that the maintenance of the home protects their health and welfare. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 21 EVIDENCE: A tour of the building was undertaken and communal areas, some toilets, bathrooms and bedrooms were visited. At the last inspection approximately 12 months ago, it was noted that most of the ground floor has been refurbished, redecorated and had revised fixtures and fittings. Since then more improvements have been made. Four bedrooms on the upper floors have been refurbished carpets replaced and fixtures and fittings renewed. This has been achieved to a very good standard and the AQAA advises that there are plans to refurbish the activity lounge later this year. The proprietor stated that she is happy with the way the refurbishment programme is going and plans to purchase a new cooker hood, replace all windows systematically and apply for funding for the development of a multi sensory room. There is clearly a lot of hard work being put into the refurbishment of the building and we were told that every time a room is completed there is an official opening ceremony in the home involving the service users. Those spoken to on the day of inspection were happy with the ongoing improvements in the home and one stated, “I love my new room it’s very clean and fresh”. The windows on the upper floors including all the new ones fitted were noted to require window restrictors to ensure service user safety and security of the home. The Kitchen area has yet to be refurbished and it was noted at the last inspection that the extractor fan above the cooker was in need of a thorough clean. This has now been done. The lounge area has been refurbished and a new wide screen wall TV has been fitted. A breakfast bar type fixture has been retained, to reflect the historical use of this room being formerly a ‘bar’. The feature of this is for some practical use also as it is used for storage of activity items, games etc. the lounge is a well decorated and well furnished room. The dining room, office and area immediately adjacent to it, including a staff toilet have also been completely refurbished with new furniture, flooring, lighting and redecoration to a good standard. The room designated as a smoking area for residents does not yet have adequate air extraction and this has again been recommended. The premises are set out on various floors and a passenger lift has been installed to reach most rooms with ground floor equivalent access. The upper floors have yet to finish being refurbished and are still in need of improvement to decoration, fixtures and fittings although it is recognised that much work has started. The average age of persons living at the home continues to increase and the majority of people are now over the age of 65 years. The registered person Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 22 has acknowledged this movement in the way the home is preparing for different challenges that onset of age brings by the relatively recent fitting of the passenger lift and other moving and handling equipment. It is recommended, however, that advice is sought from a professional or organisation that is knowledgeable about the needs of older people regarding the layout of the home, since further alterations and improvements are planned. It is important that such changes are made with the benefit of suitable advice in this way to ensure the proposals are fully in accord with the needs of older people. The extent of improvements over the preceding 12 to 24 month period is impressive. If all the forthcoming improvements to the communal areas and bedrooms on the upper floor equal that of the lower floors, the home will present as very well appointed overall. The home was well maintained and clean and hygienic on the day of inspection. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. The recruitment processes of the home do not completely have sufficient safeguards in place to ensure residents are protected. Improvements in training would help to develop the staff team, which should enhance the care of residents and improve outcomes for them. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 24 EVIDENCE: A sample of four care staff recruitment files were examined to determine the home’s practice regarding recruitment. Of these samples one carer had no recent Criminal Record Bureau (CRB) certificate but was in receipt of a POVA 1st check. A copy was available from a previous employer. CRB certificates are not transferable and a new one must be applied for, including a POVA 1st check, each time a carer is employed. Another staff member had an untranslated Spanish reference on file, no CRB and no POVA 1st check. The Registered Person must refer to the regulatory requirements regarding employment of carer’s to ensure the home complies with requirements in future. The last inspection highlighted that the Registered Person must also obtain a statement from new employees as to their mental and physical health to perform the duties required. All the files inspected had a health declaration form in place. Eleven carers are employed. Of these three are currently qualified to NVQ level 2 or equivalent, and a further three staff are to undertake NVQ level 2 and one member of staff NVQ Level 3. The proprietor and manager both have the registered managers award NVQ Level 4. This is a positive step forward since the last inspection. In reviewing the overall range of presenting needs of service users with the proprietor and Manager and then comparing these with the training and development information of carers, there were a number of training and development area ‘gaps’ still including, for example, moving and handling, POVA training, food hygiene training, continence management, challenging behaviours, and pressure area care. The AQAA states “All staff are trained in the core training requirements such as, fire and safety, health & Safety, moving & handling, infection control, safeguarding vulnerable adults, epilepsy awareness. The domestic staff are undertaking a distance Health & Safety course. The senior staff are undertaking a distance learning course on Dementia.” This was not directly the case at this inspection and at the last inspection it was acknowledged that some carers who had undertaken previous training had now left and this had created some of the development gaps within the staff team as a whole. This inspection highlighted whilst each staff member has a list of training attended and there is a rolling programme of routine training, this is not directly linked to the individual needs of carers and the tasks they have to perform. A more formalised approach was discussed with the proprietor and we are told this will be looked at with regard to a matrix formation and individual development of staff. The initial induction for new carers is an in-house design but does not meet the induction standards set out by Skills for Care 12 week induction programme. This is currently being investigated by the proprietor with a view to its implementation within the home. One staff member spoken to could not Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 25 clearly identify the fundamental parts of their initial induction and evidence of inductions was not found on the staff files reviewed. The home is currently recruiting staff mainly for weekends and there was still no evidence of any method of assessing the staff hours required based upon the needs of people living at the home, although the Assistant Manager did previously suggest that the method may be based upon the ‘Residential Forum’ method. The proprietor informed us that she had lost her copy of this so therefore there was still no evidence available to verify this. This will be further reviewed at the homes next inspection. Comments from relative surveys said ‘staff are quick to attend to my relatives needs’, ‘I think the team does its best for the residents and the carers are very good.’ At the last inspection the formal supervision of staff had only recently commenced and it was not possible to determine if the frequency of supervision met with levels set out in National Minimum Standards. We are advised in the home’s AQAA “Staff are monitored through supervision with regards to their competence and skills to perform their job. where skill gaps are identified we source appropriate training.” The proprietor tells us that the home is aiming to formalise supervision to a ratio of 6 supervisions, 1 appraisal and 2 documented observations annually. Staff spoken to confirmed they did have supervision and evidence of only some notes were seen. In discussion with staff and from observation of their practice, all went about their tasks in a friendly and supportive manner. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 27 Residents can generally be assured that all aspects of the home are managed appropriately. They should expect that quality systems be based upon appropriate consultation and that they safeguard their health and welfare. EVIDENCE: The Proprietor and Manager both have good experience of managing the service and have both completed the Registered Managers Award NVQ Level 4 since the last inspection. The inspection highlighted that the overall ethos and leadership of the service is positive and the Manager continues to foster positive and supportive teamwork. There are still some areas of noncompliance, and some standards associated with staff, recruitment and training have not reached the National Minimum Requirements carried forward from the last key inspection a year ago. The quality assurance system is being addressed in a planned and systematic way. The Proprietor has integrated an interactive quality assurance system, which is not fully operational yet. The home’s AQAA states under their plans for the next 12 months that they intend to “Fully implement the quality assurance and monitoring system. Review our Annual development plan and to take action as appropriate.” We feel this could have been enlarged upon to provide clarity of the same. The homes full approach to quality was not available for inspection on this occasion and will be reviewed at the home’s next inspection when it should have a clear format and methodology that is operational. A review of the quality approach is recommended to ensure that it meets with satisfactory principles of quality monitoring. Feedback from resident’s and relatives regarding their experience of the homes arrangements to safeguard health and welfare was mainly positive and comments included. “Chrislyn House provides a safe and warm environment for the service users” and “They put all service users first” The health and safety arrangements were generally satisfactory in that the home has monitoring systems for fire detection, hazardous substances, emergency lighting, gas safety and electrical safety, including portable appliance testing. All of these systems were sample checked to identify when the last review and test dates had been undertaken and all were satisfactory. Qualified contractors undertake some of the checks. Some aspects to health and safety were noted during this visit including the lack of window restrictors and these are stated elsewhere within this report. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 28 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 3 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 2 25 X 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 2 40 X 41 X 42 3 43 X 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Chrislyn House Score 3 3 2 X DS0000017793.V366126.R01.S.doc Version 5.2 Page 29 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 YA9 Regulation 13(4) Requirement Appropriate risk assessments must be in place for residents especially where residents are smokers and safe procedures must be adhered to at all times and staff must maintain accurate records of such. Timescale for action 31/10/08 2 YA20 13(2) 31/10/08 The storage facilities for medication should be reviewed to ensure that the home has appropriate facilities to store medications that may be prescribed for people living in the home, specifically controlled drugs. A drug cupboard should comply with the Misuse of Drugs (Safe Custody) Regulations 1973. An audit system to check the signing, omissions of medication and transcribing of medication on MARS sheets must be in place so that other possible medication issues can be monitored and good practice is always adhered to. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 30 3 YA33 18 The home must have an effective 31/10/08 staff team with sufficient numbers and complimentary skills to support residents needs at all times. This is a repeat requirement from 02/10/06 and the 30/09/07. 4 YA34 18 The recruitment policies and procedures must meet with regulatory requirements to safeguard residents. This is a repeat requirement from 30/09/07. 31/10/08 5 YA35 18 & 19 The Registered Person must ensure that there is a consistent staff training and development programme that meets the changing needs of residents. This is a repeat requirement from 02/10/06 and the 30/09/07. 31/10/08 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 YA17 YA23 Good Practice Recommendations It is recommended to improve the record of food served to ensure that adequate detail is maintained. It is recommended that all staff receive training and updates in safeguarding vulnerable adults. It is also recommended that each new employee receive a copy of the whistle blowing policy and that a copy is placed in a prominent and accessible staff area. DS0000017793.V366126.R01.S.doc Version 5.2 Page 31 Chrislyn House 3. YA24 4 5 6 YA32 YA36 YA39 It is recommended that the premises be assessed by a competent person who has specialist knowledge of older people to ascertain the appropriateness of use by older people with a learning disability. The windows on the upper floors including all the new ones require window restrictors fitting to ensure service user safety and security of the home. The workforce must be regularly updated with training to ensure they are skilled and knowledgeable as to how to deliver appropriate support to residents. The home should implement an appropriate and regular supervision and appraisal structure for all staff and ensure that appropriate records are kept. The homes quality assurance and quality monitoring systems in place should clearly measure the success in achieving the aims and objectives and statement of purpose of the home. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Chrislyn House DS0000017793.V366126.R01.S.doc Version 5.2 Page 33 - 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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