Inspection on 07/08/07 for Chrislyn House

This inspection was carried out on 7th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 6 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 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 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 7th August 2007 09:45 Chrislyn House DS0000017793.V348143.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.V348143.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.V348143.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.V348143.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th August 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 residents, whilst the mews is intended for the use of four residents who are more independent. Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken during one day and consisted of speaking with people living at the home, referred to within this report as ‘residents’, carers employed by the home, senior staff, and inspection of a selection of the home’s policies, procedures and other records. A tour of the building was also made. The Registered Manager was not in attendance and was unavailable due to being on holiday, although the Assistant Manager was able to assist the inspection process. Sampled records indicated that terms and conditions had been issued to residents and this detailed the weekly fees and what services were included as part of the fees. The inspection was informed by survey results and other information prior to the visit. At the time of the inspection 18 people were being accommodated. What the service does well: What has improved since the last inspection? Further decoration, furniture and other improvements have been added and these are to a very good standard. The regular supervision of carers has now started and the process being followed meets with National Minimum Standards. Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 6 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.V348143.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.V348143.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): Quality in this outcome is adequate based upon standards 1 and 2. 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 the information they receive to enable them to make a positive choice about where the wish to live. EVIDENCE: The Statement of Purpose remains unchanged since the previous inspection and the availability of the Service Users Guide remains the same, in that no evidence was available to indicate that people at the home have a copy of the document. No progress has been made to improve the shortfalls noted on this standard. Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 9 Each service user had a signed and dated contract (based upon a sample taken) 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 no person had been admitted to the home since the previous inspection although at this inspection the home had six vacancies. The Assistant Manager stated that an admission procedure was normally available but was not on this occasion. The document was stated to be on the office computer although there was no access to it in the absence of the Manager. Whilst there was no evidence available to ascertain the current practice of the home in admission procedures, this standard was reviewed at the previous inspection and found to meet National Minimum Standards. The Assistant Manager stated that no revision of the procedures had taken place. On this basis the standard is considered as met. See recommendation. Chrislyn House DS0000017793.V348143.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): Quality in this outcome is good based upon standards 6, 7 and 9. 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. People are protected by the arrangements for assessment of risk. EVIDENCE: Three service users files were examined on a case tracking basis. The care record indicated a comprehensive set of care decision sheets that included care outcomes and methods for the way carers should support the person. Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 11 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 were chiefly needs lead, periodic reviews and records etc. The second part is a ‘Person Centred Plan’ (PCP), which is a different model and design. The documentation is more service user focussed in its layout and the language used was appropriate. The decisions in this part of the plan are mainly long-term outcomes and describe the service users aims and wishes. It is unclear why the service has adopted two different styles of care planning approach. The latter PCP document is user friendly and has the potential to be used as the main care planning tool and is in more accordance with current thinking and empowering people to take more control of their lives and the decisions to be made. The Manager is advised to review the overall approach to ensure that the care planning pathway is clear for both carers and people using the service. The care plan pathway overall has all the required elements of assessment, decision making, monitoring and review. Whilst the structure of the plans was similar, the individual plans seen were consistent with the needs of the person for whom they were intended. The daily recording had improved and from the sample taken indicated that daily narratives were more outcome focussed and made improved links to decision making. In one sample 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. 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 when a service user told a carer they were going to the local shop to buy something. The carer checked relevant information with the person and asked the person if they needed help and what help they think they might need. 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. 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 arrangement seen support the view that this is generally undertaken at the time of a 3 monthly review, however the manager will need to ensure Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 12 that the system being used has the capacity to change a risk rating at any time to reflect changing circumstances. Chrislyn House DS0000017793.V348143.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): Quality in this outcome is good based upon standards 12, 13, 15, 16,and 17. This judgement has been made using available evidence including a visit to this service. Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 14 Residents experience a relaxed environment and have their rights respected and recognised in their daily lives. The catering arrangements mean that residents receive an adequate range of food at times to suit their lifestyle. Residents can expect to be supported by the staff team to maintain family links, friendships and to 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. 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, remain interested in attending a local drop in centre and do so on a regular basis. One person has a part time job collecting glasses in a local pub. 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 and there have been trips to Colchester Zoo and ten-pin bowling. Few people at the home have relatives although those that do are in regular contact with them and this is encouraged by the home. One person recently had bereavement and the home arranged for counselling to assist with the loss. Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 15 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 for other people wanting to use the room, or pass through it to the outside courtyard the registered person is recommended to investigate the fitting of air extraction to expel fumes. All service users spoken with stated they considered the food to be good and for the most part enjoyed the meals. 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 was 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.V348143.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): Quality in this outcome are is good based upon standards 18, 19 and 20. 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 this is progress, since this had been raised within the previous inspection report. Healthcare monitoring was well organised and a clear chronology of information was being compiled regarding medical and primary healthcare services. These included Optician, Dentist and GP etc. Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 17 Some very positive and supportive work was being undertaken to assist a person who needs to have an operation and who has a fear of hospitals. Close work is being undertaken which includes 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 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. The personal support provided was appropriate and consultative in approach. Carers knocked 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. Some of the carers had been working at the home some years and have built up positive and friendly relationships. Chrislyn House DS0000017793.V348143.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): Quality in this outcome is good base upon standards 22 and 23. This judgement has been made using available evidence including a visit to this service. Residents feel confident about how to complain and can expect to be listened to and their complaints acted upon. Residents cannot be assured that all carers are adequately trained to safeguard their welfare. EVIDENCE: The Assistant Manager stated that the home had not investigated any formal complaint during the period since the previous inspection. CSCI had not received any concerns about the service during the same period. The complaint procedure remains in situ 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 is recommended that this Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 19 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 access the main office, which is sometimes locked. All but three carers have received training in protecting vulnerable adults. The home has a distance learning pack but this has not yet commenced. Chrislyn House DS0000017793.V348143.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): Quality in this outcome area is adequate based upon the standards 24, 26, 28 and 30. 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 on the ground floor to be of a good quality standard. Residents are not fully assured that the cleaning of some parts of the home protects their welfare. Residents are not fully assured that the cleaning of some parts of the home protects their welfare. Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 21 EVIDENCE: A tour of the building was undertaken and all communal rooms some toilets, bathrooms and bedrooms were visited. Since the last inspection approximately 12 months ago, most of the ground floor has been refurbished, redecorated and revised fixtures and fittings. This has been achieved to a very good standard. The Kitchen area has yet to be refurbished and whilst generally clean, it was noted that the extractor fan above the cooker was in need of a thorough clean. The lounge area has been refurbished and a new wide screen wall TV has been fitted, although the seating layout prevents everyone having a clear view of the TV. It was noted that a breakfast bar type fixture has been retained, presumably to reflect the historical use of this room being formerly a ‘bar’. Whilst the feature is of some practical use, its retention appears to have limited the options available for seating and there appeared to be little option other than to have seats against the wall in a row giving a rather institutional feel to what is otherwise a well decorated and well furnished room. The dining room has also been completely refurbished with new furniture, flooring, lighting and redecoration to a good standard. The well-appointed room was rather jaded by the presence of a stainless steel trolley containing all the requirements and condiments to equip tables for a meal and gave a rather institutional feel to the room. It was noticed that a number of plastic bottles containing sauce were on the trolley and the spillage of sauce on most of these were attracting flies. This was pointed out to the Assistant Manager who made arrangements for the bottles to be washed. It is recommended that the storage of cutlery, equipment and condiments be reviewed to improve the risk of contamination and restore a more domestic feel to the room. The office and area immediately adjacent to it, including a staff toilet, has been refurbished 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 be refurbished and are in need of improvement to decoration, fixtures and fittings although some 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 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 Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 22 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 month period is impressive. If 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. At present, however, there are areas that lack attention to minor matters that detract from the overall impact of the home. Chrislyn House DS0000017793.V348143.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): Quality in this outcome is poor based upon standards 31, 32, 33, 34, 35 and 36. This judgement has been made using available evidence including a visit to this service. Residents are not assured that the home’s recruitment practice and adequacy of staff training protect them. Residents are supported by intuitive carers and value the relationships they have with them. Residents are not assured that the home adequately identifies the number of carers and the knowledge and skills they must possess to provide them with safe and appropriate care at all times. Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 24 EVIDENCE: A sample of files was examined to determine the home’s practice regarding recruitment. Of these samples one carer had no recent Criminal Record Bureau (CRB) certificate. A copy was available from a previous employer although this was issued approximately 7 months prior to commencing employment at Christlyn House. CRB certificates are not transferable and a new one must be applied for, including a POVA 1st check, each time a carer is employed. The Registered Person must refer to the regulatory requirements regarding employment of carer’s to ensure the home complies with requirements in future. The Registered Person must also obtain a statement from new employees as to their mental and physical health to perform the duties required. This is a regulatory requirement. Eleven carers are employed. Of these three are currently qualified to NVQ level 2 or equivalent, although it was stated that a further six carers have recently enrolled to train for this qualification, which is positive. This is below the level contained within National Minimum Standards of 50 . In reviewing the overall range of presenting needs of service users with the Assistant Manager and then comparing these with the training and development information of carers, there were a number of training and development area ‘gaps’ including, for example, food hygiene training, continence management, challenging behaviours, and pressure area care. It is 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. Whilst each staff member had 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. 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. The deployment of carers illustrated by a staff roster for the most recent complete week prior to the inspection was 411 hours in total. This did not include senior cares that work in a supernumerary capacity. There was no evidence of any method of assessing the hours required based upon the needs of people living at the home, although the Assistant Manager did suggest that the method may be based upon the ‘Residential Forum’ method. There was no evidence available to verify this. The formal supervision of staff has recently commenced and therefore is was not possible to determine if the frequency of supervision met with levels set out in National Minimum Standards. This will be further reviewed at the next inspection. Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 25 In discussion with staff and from observation of their practice, all went about their tasks in a friendly and supportive manner. Chrislyn House DS0000017793.V348143.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): Quality in this outcome is adequate based upon standards 37, 39 and 42. This judgement has been made using available evidence including a visit to this service. Chrislyn House DS0000017793.V348143.R01.S.doc Version 5.2 Page 27 Residents are not assured that all aspects of the home are managed appropriately. They should expect that quality systems be based upon appropriate consultation and to safeguard their welfare. Resident’s experience of the homes arrangements to safeguard their health and welfare is mainly positive. EVIDENCE: The Manager has long experience of managing the service and is currently working toward a qualification (Registered Managers Award). The inspection highlighted that the overall ethos and leadership of the service was positive and the Manager fosters positive and supportive teamwork. There are areas of non-compliance, however, and most standards associated with staff have not reached the National Minimum Requirements carried forward from the last key inspection a year ago. The quality assurance system should be addressing these shortfalls in a planned and systematic way. The homes approach to quality was not available for inspection although some sample questionnaires were viewed that had been sent to relatives. These had not yet been returned. The questionnaires would benefit from review to ensure that appropriate questions are being asked and that suitable response options are available. For example some of the questions were not objective and were somewhat leading in there construction. Some asked two questions in the same sentence but with only one response option. The home does not have a quality assurance policy and procedure and it is unclear how the questionnaire is completed for people who require help from carers for example. A review of the quality approach is recommended to ensure that it meets with satisfactory principles of quality monitoring. The health and safety arrangements were 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. Two aspects to health and safety were noted during the visit and these are stated elsewhere within this report. Chrislyn House DS0000017793.V348143.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 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 2 40 X 41 X 42 3 43 X 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Chrislyn House Score 3 3 3 X DS0000017793.V348143.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 YA1 Regulation 4,5 Requirement Residents must be provided with a Service Users Guide. This is a repeat requirement from 02/10/06. The workforce must be trained to ensure they are skilled and knowledgeable as to how to deliver appropriate support to residents. This is a repeat requirement from 30/06/06 and 02/10/06. The home must have an effective staff team with sufficient numbers and complimentary skills to support residents needs at all times. This is a repeat requirement from 02/10/06. The recruitment policies and procedures must meet with regulatory requirements to safeguard residents. The Registered Person must ensure that there is a staff training and development programme that meets the changing needs of residents. This is a repeat requirement from 02/10/06. DS0000017793.V348143.R01.S.doc Timescale for action 30/09/07 2. YA32 18 30/09/07 3. YA33 18 30/09/07 4 YA34 18 30/09/07 5. YA35 18 30/09/07 Chrislyn House Version 5.2 Page 30 6. YA39 24 The Registered Person must 30/09/07 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. This is a repeat requirement from 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 residents from the effects of passive intake of tobacco fumes. 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 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. 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. It is also recommended to review the seating layout in the lounge area and/or relocate the TV. It is recommended that the air extractor fan in the kitchen be thoroughly cleaned to avoid any risk of dross contamination. It is further recommended that condiments are cleaned where necessary after use and stored in a suitable cupboard until required. It is recommended that the Manager complete a course leading to the Registered Managers Award or equivalent. The Registered Person is recommended to review the health and safety aspects of the home to ensure that known risks are reduced to a safe standard. (See YA16 and YA30 above) DS0000017793.V348143.R01.S.doc Version 5.2 Page 31 2 3 YA17 YA23 4 YA24 5 YA30 6 7 YA37 YA42 Chrislyn House Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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