Inspection on 15/06/07 for Chypons

This inspection was carried out on 15th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Chypons 20/04/10

Chypons 28/04/09

Chypons 06/05/08

Chypons 05/12/07

Chypons 21/03/07

Chypons 31/05/06

Chypons 21/03/06

Chypons 16/06/05

Chypons 09/11/04

Chypons 13/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Chypons Clifton Hill Newlyn Penzance Cornwall TR18 5BU Lead Inspector Ian Wright Unannounced Inspection 08:00 15th and 16th June 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chypons Address Clifton Hill Newlyn Penzance Cornwall TR18 5BU 01736 362492 01736 360399 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) Mr Geoffrey Walden Knights Care Home 27 Category(ies) of Dementia - over 65 years of age (3), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (27) Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 27 adults of old age (OP) Service users to include up to 3 adults with dementia (DE) [E] Service users to include up to 3 adults with a mental illness (MD) [E] Total number of service users not to exceed a maximum of 27 Date of last inspection 21st March 2007 Brief Description of the Service: Chypons provides accommodation and personal care for up to 27 older people, three of who may have dementia and a further three may have a mental illness upon admission. The home is situated in the village of Newlyn, near to Penzance and is easily accessible by road. All the amenities of the village and town of Penzance are close by, although there is quite a steep hill leading up to the home. There is ample car parking space for visitors in the homes grounds. The home consists of two inter-linked wings. Most of the bedrooms are for single occupancy and have en suite bathrooms. The main lounge and several of the bedrooms have spectacular sea views. There is a large lounge/ dining room and hairdressing/beauty salon. There is a small, paved terrace area on the upper floor to enable service users to sit outside if they wish. The home has a lift to enable service users to access the upper floor. The entrance to the building has suitable access for people with disabilities. The home has equipment and grab rails at strategic points to assist people with physical disabilities. The home is privately owned and the registered provider employs a manager to assist them to run the home on a day-to-day basis. A team of care staff, including senior carers and ancillary staff provide care and support to service users. At the time of the inspection fees range from £365-425 per week. Additional charges are made for hairdressing, newspapers and personal items. A copy of this inspection report is available via the home’s management or the CSCI website. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Key Inspection took place over sixteen hours over two days. All of the Key Standards were inspected. The methodology used for this inspection was: • To case track six people who use the service. This included interviewing the people who use the service about their experiences and inspecting their records. • Interviewing five staff about their experiences working in the home. • Informal discussion with staff and other people who use the service. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? Care plans seem comprehensive, are regularly reviewed and contain a risk assessment. The medication policy has been updated. Those people who use the service have a lock on their bedroom doors if they want one, and everyone has a security box in their bedrooms. Staff appear to now use the protective clothing, such as aprons, which is provided for them. Doors were not observed Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 6 to be wedged open, and a number of automatic door closing devices have been purchased. These allow people to have their doors open, but through a vibrating mechanism ensure the door will shut if the fire alarm rings. 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. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is generally good, although evidence of preadmission assessment must be improved. This judgement has been made using available evidence including a visit to this service. The registered provider has developed a statement of purpose / service user guide. Although the service user guide is generally good, this needs to be issued to people who use the service, and/or their representatives. The registered provider has developed a contract / statement of terms and conditions of residency and this has been issued to people who use the service. The provision of suitable information ensures people who use the service are aware of the services the registered provider offers. This information also helps ensure people who use the service are made aware of their rights and responsibilities. The registered provider’s assessment procedure needs improvement. For example when assessments are completed these must be documented. Suitable assessment procedures ensure the registered provider only accommodates people for whom the provider can suitably meet their needs. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 9 EVIDENCE: The service user guide / statement of purpose was inspected. This document is satisfactory. Copies of the document are provided in each bedroom, and there are copies available in communal areas. Copies should also be provided, where necessary, to next of kin. This is important for example if people who use the service have limited understanding e.g. due to cognitive impairment. The registered provider has an assessment policy and this is satisfactory. Some people who use the service said they remembered an assessment occurring before they moved in. Some people who use the service said they were able to visit the home before moving in, and others said a relative visited on their behalf. However, the pre admission assessment must be documented. In some cases a copy of a social services / health assessment has been obtained by the registered provider. This obviously helps the provider to make decisions regarding the service user’s suitability to live in the home. All people who use the service have been issued with a statement of terms and conditions of residency / contract. Copies of this documentation are available on the files of people who use the service. The service does not provide intermediate care. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is generally good; although as the medication system needs significant improvement the overall outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have a generally satisfactory care plan for which there is suitable evidence of regular review. Suitable care plans help to ensure people who use the service receive all the care they need, for example in a consistent manner. There is suitable evidence that staff ensure health care needs are met. Improvement is required to the medication system. This will ensure people who use the service can be assured their medication is managed to a satisfactory standard. People who use the service said they felt staff worked with them in a manner, which respected their privacy and dignity, and this was also evident from the inspectors’ observations. EVIDENCE: Care plans for some people who use the service were inspected. These appeared to be satisfactory, and contained suitable information to assist staff Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 11 to provide care. It would be useful if care plans had a brief history of the service user’s life (e.g. where did the person live? Do they have a family? Do they have any specific interests? What job did they do?). All care plans need to have a photograph attached to them, as long as the individual agrees to this. This helps staff or agency staff, who for example are new to the service, to be able to identify the individual if they have limited communication skills (e.g. so staff administer medication to the right person). Care plans include a satisfactory risk assessment e.g. regarding manual handling. Although some people who use the service did not appear to be aware of their care plans, all people who use the service said the care they received was appropriate and carried out in a manner according to their wishes and needs. There was satisfactory evidence care plans are reviewed for most service users, although this needed to be more evident for some care plans. Health care support appears to be satisfactory. People who use the service said they could see a doctor or other medical practitioner when this is necessary. The inspector spoke to a district nurse who said, in their view, care was satisfactory. The medication system was inspected. Medication is stored in cupboards in a locked medication room and administered via a monitored dosage system. The operation of the system is however poor. Several errors in the administration and recording of medication were noted during the inspection: • Dosages of medication administered to several people who use the service were not signed for, although they appear to be administered. • Medication was not given for one person. Although this was coded on the medication sheet as not given, the reason was not recorded on the back of the medication sheet as required. • Anti depressant medication for one person who uses the service was not administered on five occasions, although the medication sheet was signed to say it had been. • Medication for one of the people who use the service was prescribed to be administered at night time although is administered at tea time. The manager said this was at the individual’s request. However, if this is the case, the manager must liaise with the GP to check this is appropriate, and follow their advice. • There was some overstock of some medication. This should not be reordered until stock is used up. • Some medication was being ‘secondary dispensed’ i.e. transferred from individual containers to a dosset container. This should not occur due to the risk of error. The registered provider needs to ensure the medication is monitored to a higher standard, and ensure there is more vigilance to avoid error. The manager said all the staff that administer medication have received formal training, although some further supervision needs to occur to ensure their Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 12 practice is improved. If any night staff administer medication, at any time, they also require professional training. People who use the service spoke positively regarding the attitude of staff, and said staff respected their privacy and dignity. People who use the service said staff always knock on their doors, and post is always received unopened. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are flexible to meet the needs of people who use the service. Some activities are offered. This ensures people who use the service can have a daily routine that suits their needs and have various opportunities for social activity. People who use the service have opportunity to have visitors. People who use the service are encouraged to make choices regarding how they live their lives, and can maintain control over their financial affairs. Arrangements for meals are good and ensure that people who use the service have a varied and wholesome diet. EVIDENCE: The first day of the inspection started at 08:00 so the inspector could observe the morning routine. This was very relaxed, but organised. It was clear people who use the service could get up when they wanted to, and staff support was professional, relaxed and unhurried. The inspector was able to speak to many of the people who use the service and all said they could get up and go to bed when they wanted to. A limited amount of activities are available for example a music afternoon. Occasional outings were arranged last year. The manager said she wanted to arrange further activities such as quizzes etc. The manager has tried to arrange for the local church / chapel, and the local library, to visit the home Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 14 but has not been able to receive support from these organisations. The inspector spoke to people who use the service, and they said they were happy to occupy themselves. Many people received a daily newspaper, and one lady enjoyed doing her knitting. People said staff were always friendly, and a number of people appeared to have good support from relatives. People who use the service said they were able to receive visitors when they wished either in the lounge or in their bedrooms. There are fantastic views from most rooms in the home which people said they very much enjoyed. People who use the service said they felt they could exercise choice over their lives for example how to spend their time, what they could wear etc. Management look after some small amounts of money on behalf of people who use the service. Staff do not act as appointee for government financial benefits, for any of the people who use the service. Records are kept of fees paid to the registered provider. The registered provider looks after some valuables on behalf of people who use the service. Records of cash looked after on behalf of people who use the service are satisfactory. People who use the service said they felt their personal belongings were safe, and said nothing that belonged to them had disappeared. The registered provider has ensured each person who uses the service has a safety deposit box in his or her bedrooms. A minority of people who use the service have a lock on their bedroom doors. Management said all new people admitted to the service would be offered this facility. Existing people who use the service have been asked if they want a lock on the door. Where people have said no or this is not appropriate, this has been recorded in their files. The inspector shared a meal with some people who use the service. Food served was of good quality and there was a choice available of main course for people. People who use the service all said they were very happy with the food provided. They said there was always enough food and meals were well cooked. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered provider has suitable complaints and adult protection procedures. This should assist in ensuring people who use the service can be assured any concerns, complaints or allegations are taken seriously and dealt with effectively. However, the registered provider must ensure pre employment checks are completed according to the law. This will help to ensure people who use the service, are protected against having staff working with them who are unsuitable to work in a care environment. EVIDENCE: Procedures regarding complaints and adult protection appear to be satisfactory. The registered provider or Commission for Social Care Inspection have not received any complaints regarding this service. Many service users described staff as ‘kind’, and the people the inspector spoke to said they were not aware of any poor or abusive practice. Staff the inspector spoke to also said practices within the team were to a good standard. Some staff have received training regarding the awareness and prevention of abuse. However, a significant number of staff have not received a ‘POVA First’ check (before they started employment) or a full Criminal Records Bureau check. The registered provider therefore cannot be assured there are not staff working in the home that are not suitable to be working in a care environment. This matter is discussed further in the staffing section of the report. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26 Quality in this outcome area is in many respects generally good, however as bathing and toilet facilities are in some respects poor, the overall is Adequate. This judgement has been made using available evidence including a visit to this service. Chypons provides a suitable facility to provide care for elderly people. The building was clean, light, warm and generally well maintained at the time of the inspection. However some aspects of bathing and toilet facilities need significant improvement. Generally however people who use the service can be assured that Chypons provides suitable facilities to meet their needs. EVIDENCE: The building was inspected. On the main floor there is a large through lounge and dining room. This has spectacular sea views of Mounts Bay from the town of Penzance to Newlyn Harbour. There is a small outside seating area where people can enjoy the view. Toilet and bathroom facilities are suitable and assisted bath facilities are available for people with mobility problems. However the bathroom on the first Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 17 floor is generally not used. There were some bags of linen stored in the room which could present a fire risk. The items should be removed and stored somewhere else to prevent this risk. The registered provider is thinking of adapting the upstairs facilities to improve bathing facilities and storage. This can be done as long as there is no decrease in the size of bedrooms or available communal facilities. One of the downstairs toilets has a curtain rather than a door. The registered provider discussed with the inspector proposed improvements to downstairs toilet facilities. This is again satisfactory as long as there is no decrease in the facilities available. At least three of the toilets in the older part of the building do not have a lock on them. This issue has previously been notified to the provider on two occasions. Previous reports have also stated how the regulations have not been complied with regarding this issue. This matter has not been resolved for a considerable period of time and subsequently, if the matter is not complied with within the timescale set, the Commission may take enforcement action. This matter must now be addressed to ensure people who use the service have satisfactory privacy when using the toilet. Decorations are generally satisfactory, although some areas, for example, in parts of the corridors will need some redecoration shortly. There are a number of interesting pieces of sculpture around the home, and interesting paintings in a modern style. The home has two lifts. One lift links the ground floor with the lower floor, and a second lift links the ground floor to the first floor. There is also a staircase. A short chairlift allows people with mobility problems to access two of the bedrooms. All bedrooms are for single occupancy and eighteen have an ensuite toilet. Many have lovely sea view, and all are pleasantly furnished and decorated. There are suitable laundry and kitchen facilities. People who use the service were positive regarding the facilities provided. The registered provider said people who use the service had been asked if they wanted a lock on their bedroom doors. Locks have been provided where requested. People subsequently admitted to the service will be offered this facility. The building was clean and hygienic on the day of the inspection. The building appears to be generally well maintained. However three of the bedroom carpets are stained and need to be replaced. The registered provider said this issue is in hand so a statutory requirement, on this occasion, has not been made regarding this issue. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory, and this ensures people who use the service receive appropriate levels of support when they need it. Recruitment procedures, particularly in regard to Criminal Record Bureau checks, need considerable improvement so people who use the service can be assured they are in safe hands and protected at all times. Staff training requires improvement so staff have appropriate knowledge and skills to support people who use the service. Requirements regarding recruitment checks and staff training have been renotified a considerable number of times. Failure now to take action to meet these requirements could result in enforcement action. EVIDENCE: On the first day of the inspection the following staffing was provided: • • • • • • One One One One Two Two member of staff from 07:00 to 14:00 member of staff from 07:00 to 17:00 member of staff from 07:00 to 13:00 member of staff from 13:00 to 21:00 members of staff from 17:00 to 21:00 waking night staff from 21:00 to 08:00 In addition the manager was on duty from 08:00 to 18:00 and ancillary staff (cooks, cleaners) were on duty. People who use the service were positive Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 19 regarding the support they received from staff, and comments were made that staff were approachable and worked well as a team. The registered provider has a suitable approach to enabling staff to have the opportunity to obtain a national vocational qualification (NVQ) in care. The preinspection questionnaire stated that in May 2007 35 (6 out of 17) care staff had at least an NVQ 2 in care, with two further staff working towards this qualification. Recruitment checks completed when staff are employed are overall poor. The records of ten care staff (i.e. all the staff on duty on 15th June 2007) were inspected. The records of six other staff that have commenced employment since March 2007 were also inspected. Records show the majority of staff have, on file, an application form, and records regarding training received. However, there is no evidence that the majority of staff have, as required by the regulations; • Proof of identity • A statement by the person as to his mental and physical health. Although the registered provider has obtained two references for the majority of staff recently employed, four staff only had one reference each. There are also significant problems with procedures regarding criminal record checks: • No staff that have been recently employed have a Protection of Vulnerable Adults ‘First’ (POVA First) check. • Only four of the sixteen staff whose files were assessed had a Criminal Records Bureau (CRB) check. One member of staff had a CRB from a previous employer, however these checks are not transferable between employers. As a consequence an immediate requirement has been issued. This states the registered provider must ensure any new staff have a POVA First check before they commence employment, and all staff have a subsequent CRB check completed. A requirement was made regarding this matter in the previous report. The requirement has now been notified on a total of eight occasions. Staff must receive appropriate POVA First and CRB checks as required by law so people who use the service are not put at risk. Failure of the registered provider to ensure all existing staff, and staff employed from the date of this report, have these checks could result in enforcement action. The registered provider must also inform the Commission of what supervision arrangements will be put in place regarding staff that do not have a satisfactory CRB disclosure. Confirmation regarding these matters must be made in writing to the Commission for Social Care Inspection as soon as possible. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 20 Training records were also inspected for the ten staff in the sample. By law all staff must have: • Regular fire training in accordance with the requirements of the fire authority. • There must always be at least one first aider on duty (at appointed person level). • All staff must have manual handling training. • All staff must have basic training in infection control. • If staff handle food they must receive training regarding food hygiene. • All new staff must have an induction and there should be a record of this. There are gaps in training required by regulation. For example: • Fire Training. Four staff had attended a formal course, but no other records of fire training were seen. • First Aid. Five staff in the sample had an up to date approved persons first aid certificate. However none of the night staff had a first aid certificate. • Manual Handling. Only one of the staff in the sample had up to date manual handling training. • Infection control. Six of the staff in the sample had training in this area. Other staff do not appear to have received this training. • Food hygiene. Three of the staff in the sample had training in this area. A requirement was made regarding this matter in the previous report. The requirement has previously been notified on a total of four occasions and is subsequently renotified. Staff must receive suitable training as required by law so people who use the service and staff are not put at risk. Failure of the registered provider to provide appropriate training for staff could result in enforcement action. There is evidence that some staff have received induction training. Seven of the ten staff, whose files were fully assessed, had a copy of an induction checklist on their files. In addition the files of six staff, who started from March 2007, (four of whom were auxiliary staff) were assessed. None of these had any record of staff induction. The induction checklist used is very brief, and this needs expansion to include issues related to the philosophy of care in the home, and procedures related to the care of people who use the service. A requirement was made regarding this matter at the previous inspection on 21st March 2007, and this is renotified. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management arrangements currently do not meet regulatory requirements. The registered provider must ensure an application for a registered manager is submitted to the Commission for Social Care Inspection, as a matter of priority, so this can be determined. Having an approved registered manager in charge of the home will ensure there is a legally accountable person managing the home on a day to day basis. The registered provider must improve the home’s approach to managing quality. This will assure people who use the service that there are suitable mechanisms in place for improving areas of the service where this is required. The management of monies of people who use the service is satisfactory, so if applicable, people can be assured staff look after their money appropriately. The management of health and safety needs significant improvement so people who use the service can be assured they live in a safe environment. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 22 EVIDENCE: The registered provider Mr G Knights lives locally and is present at the home several times a week. Mr Knights was present for part of the second day of the inspection, including for the first part of the feedback. A manager, Ms Donna Newton, is employed. Although the inspector was told it is the intention of the registered provider to submit an application to the Commission for Ms Newton to be the registered manager, this has now been outstanding for a considerable period of time. The registered provider has been notified now on five previous occasions. Previous reports have also detailed how this requirement has not been met. Failure of the registered provider to submit an application for a registered manager, within the timescale set, could result in enforcement action. Although some action has been taken towards meeting the requirement of having a quality assurance system, some work still needs to be completed. Recently the registered provider completed a survey of the views of people who use the service, and the results are positive. However, no staff or resident meetings appear to take place. An annual development plan or other quality assurance measures do not appear to be in place. The registered provider needs to develop a quality assurance policy outlining what measures are in / will be put in place, and this needs to be implemented. The registered provider has been notified now on three occasions regarding this matter. Previous reports have also detailed how this requirement has not been met. Failure of the registered provider to introduce a quality assurance system within the timescale set could result in enforcement action. Other policies and procedures, unless stated elsewhere in this report, appear to be satisfactory. Policies should also have details of the CSCI office now this is situated in Devon. Management of the monies of people who use the service is generally satisfactory as outlined under NMS 14. The registered provider has a satisfactory health and safety policy. The fire prevention system was last serviced in December 2006. The fire extinguishers were serviced in May 2007. The home has a fire risk assessment, which was developed in 2003. This should be reviewed in liaison with the fire authority. Staff last tested the fire alarms on 14th June 2006, and according to records these appear to be tested regularly. Emergency lighting is only being tested erratically i.e. 18/1/2007, 1/3/2007 and 23/4/2007. During the inspection some of the emergency lights were on, including one, which was flickering. An immediate requirement was left for Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 23 emergency lighting to be tested at appropriate intervals as recommended by the fire authority, and for the registered provider to confirm in writing when any necessary maintenance work is completed. Health and safety risk assessments were completed in April 2007. There are to a good standard, although there is not a risk assessment regarding the prevention of legionella (or what appears to be any precautionary measures regarding this matter) as required by regulation. The Health and Safety Executive publishes useful publications regarding what needs to occur regarding this matter; for example see: http:/www.hse.gov.uk/pubns/indg253.pdf Advice can also be sought regarding this matter via the local environmental health department, which is the regulatory authority regarding this issue. The passenger lift appears to be satisfactorily maintained, for example this was last serviced in March 2007. The stair lift was last serviced in October 2006. There are records that the gas cooker was serviced in January 2007 although some work was recommended. The boiler appears to be last serviced in August 2006. There does not appear to be a gas safety certificate, this must be obtained, if necessary, and available for inspection. Portable electrical appliances were tested in April 2007. No records were available regarding whether an electrical hardwire certificate has been obtained. This test is required every five years, must be completed, and the certificate available for inspection. There is a record that the mobile hoist was serviced in September 2007. There is an overhead hoist in one of the bathrooms, but there is no documentation to state this has been serviced since January 2006. Similarly there are no records that specialist baths have been serviced. Again, this equipment must be serviced according to manufacturers instructions, and Health and Safety Executive (HSE) guidelines to ensure it is safe. Training in various aspects of health and safety need to take place so the registered provider meets legislative requirements (e.g. moving and handling training, fire training). This is outlined in the previous section of the report. Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 1 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14(1) Requirement The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so: (a) the needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user. Previous timescale of 01/07/07 not met. 2nd Notification Timescale for action 01/08/07 Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 26 2. OP9 13(2) The registered person shall make 01/08/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (For example the issues of concern raised in the report need to be addressed, and appropriate monitoring of the system, by the registered provider, need to take place). The registered person shall make 01/10/07 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. Also, the registered person shall having regard to the number and needs of the service users, ensure that there are provided at appropriate places in the premises, sufficient numbers of lavatories, and of washbasins, baths and showers fitted with a hot and cold water supply. ( For example the registered provider needs to provide; • A lockable door on each bathroom and toilet (with an override facility if necessary) Previous timescale of 01/06/07 not met. 3rd Notification • A well maintained bathroom facility on the first floor of the home) 3. OP21 OP10 12(4)(a) 23(j) Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 27 4. OP29 19(1) Schedule 2 The registered provider shall not 01/08/07 employ a person to work at the care home unless: (a) The person is fit to work at the care home; (b) The registered provider has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2 (for example two references, proof of identity and a statement by the person as to their mental and physical health.) Previous timescale of 01/06/07 not met. 3rd Notification The registered person shall not employ a person to work at the care home unless the person is fit to do so. Satisfactory checks must be completed on the person to ascertain this. (For example a Protection of Vulnerable Adults ‘First’ check and a Criminal Records Bureau check etc. as outlined in Schedule 2 of the Care Homes Regulations 2001). Immediate Requirement Previous timescale of 01/06/07 not met. 8th Notification The registered provider must inform the Commission in writing, as soon as possible, what supervision arrangements will be put in place for staff that do not have a satisfactory CRB disclosure. 16/06/07 5. OP29 18. 19 Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 28 6. OP29 18. 19 7. OP29 18. 19 The registered person shall ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. This must include suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. (For example such training must include training as required by regulation such as infection control, food hygiene, Fire training, manual handling training and first aid. [Previous timescale of 01/07/07 not met] 5th Notification The registered person shall ensure that the persons employed by the registered person to work at the care home receive suitable structured induction training. Suitable records must be maintained regarding this. [Previous timescale of 01/07/07 not met] 2nd Notification 01/01/08 01/08/07 Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 29 8. OP31 7, 8, 9 The registered provider shall appoint an individual to manage the care home where— (a) There is no registered manager in respect of the care home; and (b) The registered provider (i) Is an organisation or partnership; (ii) Is not a fit person to manage a care home; or (iii)Is not, or does not intend to be, in full-time day to day charge of the care home. [Previous timescale of 01/06/07 not met] 5th Notification The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home (For example the registered provider must develop a policy regarding what measures to maintain and improve the quality of service will take place, and this must be implemented within the timescale set). [Previous timescale of 01/06/07 not met] 3rd Notification 01/09/07 9. OP33 24(1) 01/09/07 Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 30 10. OP38 12, 13(4) 23(2)(c), 23(4)(c) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Any unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Any equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order (For example emergency lighting must be repaired and tested at intervals recommended by the fire authority. When the equipment is repaired the Commission must be notified in writing by no later than the timescale indicated in the next column.) Immediate Requirement 18/6/07 06/07/07 Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 31 11. OP38 12, 13(4) 23(2)(c) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Any unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Any equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order (For example: • Review the home’s fire risk assessment and take any appropriate action. • Ensure a risk assessment is completed regarding the prevention of legionella, and any necessary preventative measures are taken to prevent legionnaires disease. • Ensure the electrical hardwire circuit is tested at least every five years, and a safety certificate is obtained. • Ensure a gas safety certificate is obtained. • Ensure all hoists and specialist baths are serviced according to the manufacturers instructions and within HSE guidelines. Clear records of this should be kept. 01/09/07 Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Chypons DS0000055781.V343916.R01.S.doc Version 5.2 Page 34 - 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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