CARE HOMES FOR OLDER PEOPLE
Chypons Clifton Hill Newlyn Penzance TR18 5BU
Lead Inspector Lowenna Harty Announced 16 June 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chypons Version 1.10 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 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) registration, with number Mental Disorder, excluding learning disability or of places dementia - over 65 years of age (3) Old age, not falling within any other category (27) Chypons Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9 & 12 November 2004 Brief Description of the Service: Chypons is a care home providing accommodation and personal care for up to 27 older people, three of whom 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 easil accessible by road. All the ameinties of the village and nearby town 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 itself is set in its own grounds and 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 and 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. They are assisted by a deputy manager, a team of care staff and ancillary staff including kitchen and cleaning staff and a maintenance manager. Chypons Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection as part of the home’s annual inspection programme, which took place across three days on 16, 17 and 21 June 2005. In total the inspector was at the home for twelve and a half hours and undertook the following activities: 1. Inspection of records, including assessment information and care plans 2. Discussion with the registered provider, person currently in charge of the home and deputy manager on how it operates on a day-to-day basis 3. Inspection of the premises 4. Interview with two members of staff 5. Interviews with ten residents some in the main lounge and some in their own rooms. 6. Interview with a visiting professional 7. Consideration of written representations of relatives of residents received prior to the inspection 8. Review of the pre-inspection information provided by the home prior to the inspection. 9. Observation of the daily life of the home. Overall the home is steadily improving and provides a good standard of care to the residents there. The inspector would like to thank the registered provider, person currently in charge of the home, staff, residents and all those who contributed for their kind assistance in the conduct of this inspection. What the service does well:
The home is, for the most part, comfortable and homely. It is conveniently situated within reach of local public transport routes and the nearby town of Penzance. The lounge and several of the bedrooms have spectacular views of
Chypons Version 1.10 Page 6 the coastline. The atmosphere of the home is light, airy and pleasant and all parts of the home were warm. The person currently in charge and the deputy manager try to visit all residents before they come into the home to ensure that it is suitable for them. Where they are referred by local health or social care professionals the person in charge of the home makes sure that full information is sent about them so that they can be sure that the home will be able to meet their needs. Visitors are welcomed in the home, including professional health and social care workers who provide ongoing support to residents where this is needed. Upon their admission, residents’ care is planned and their needs, wishes, preferences, including religious and cultural needs are considered. At the time of this inspection, all the residents had comfortable, single rooms, which were furnished appropriately. Those that wish to do so are able to bring items of their own furniture. The home has a clear, written complaints procedure, which is posted on the wall of each bedroom so that they and their relatives are aware of what to do should they want to make a formal complaint about the home. This includes information on how they can access the Commission should they wish to do so. There are good arrangements in place to ensure that residents’ financial interests are protected and the home’s environment is mainly safe, clean and hygienic. There is a team of care staff with additional non-care staff to help with cleaning, catering and maintenance work to meet residents’ needs. There is a relatively low turnover of staff and rare use of agency staff so residents are more able to build up a relationship with the staff working with them. Most of the residents interviewed in the course of the inspection said that staff provide them with a good standard of care, are kind and patient. They appeared to treat residents with courtesy and respect at all times. What has improved since the last inspection?
The home is steadily improving. The information given to prospective residents about the home has been updated so that they are better informed about whether it would be suitable for them or not. There have been several, significant improvements to the way the home manages medication, following a previous, detailed inspection of this by a Pharmacy Inspector from the Commission. This includes improvements to staff training, record keeping, dispensing and administration of medicines. The home’s activities programme has improved, with the introduction of a variety of activities for residents provided by staff in the afternoons. One resident was particularly appreciative of the musical entertainment that has recently been introduced. The registered provider has also employed the services of a chiropodist and physiotherapist to visit the home and provide assistance to residents at no additional cost to them. The registered provider is planning an extensive renovation of the home’s environment and work in this respect is progressing steadily. He has now drawn up a maintenance plan and started the process of keeping the
Chypons Version 1.10 Page 7 Commission updated and informed as tasks are completed so that progress can be monitored. This is necessary because of the extensive nature of the planned work and therefore relatively lengthy timescale that is needed for completion. There have been essential improvements to the home’s water and heating systems, the kitchen has been upgraded and work is continuing on this. Several bedrooms have been re-decorated and provided with new furniture and the hall and main stairs have been re-decorated and re-carpeted. The hairdressing salon is being renovated to provide a pleasant environment for residents to visit and work on this is almost complete. One of the bathrooms upstairs is being renovated and work is commencing to improve the bathing and washing facilities downstairs. Residents are now informed of announced inspections through the posting of a notice in their main lounge so that they can request a private interview with the inspector if they wish. What they could do better:
There have recently been some major changes in the management of the home, following the registered manager’s resignation, which was quite sudden. The information given to prospective residents needs to be updated so that they have accurate information as to who is in charge of the home. The registered provider needs to appoint a new manager and make arrangements for them to be registered with the Commission so that residents and their representatives can be confident the home is properly run. The registered manager is currently drawing up new contracts for residents, which need to be completed to provide re-assurance that their terms and conditions will be fair. This is particularly relevant in relation of proposed room changes, while bedrooms are upgraded. Residents need reassurance that they will only be asked to move to another room if it is in their best interests and with their full agreement. Whilst prospective residents’ needs are assessed, the home’s assessment format should be improved so that it fully reflects the health, welfare and social care needs of residents in writing. Currently assessments are completed mainly using a tick-box system that provides little information about the person who is being assessed. Good assessment information is important to give care staff working with new residents have as much information about how to help them as possible. It can also be essential in resolving disputes that may arise about the home’s suitability to meet the needs of any resident. Likewise, their written care plans should be fully completed, including their personal profiles and medical histories and residents or their representatives should be asked to sign up to them. This is a good way of ensuring their participation in the care planning process and agreement with the care that is being provided to them. There are further improvements needed to ensure that medicines are safely managed in the home. This
Chypons Version 1.10 Page 8 includes updating the written policies and procedures and guidance given to staff and environmental improvements to the storage and preparation areas. There are a number of specific improvements needed to modernise the home, make it fully safe and improve arrangements for protecting residents’ privacy and dignity. This includes upgrading the bathrooms and toilets, particularly those downstairs so that they all have lockable doors and hand-washing facilities. Flooring in the laundry area needs to be easily washable to prevent the risks of infection. Ramps leading from the main lounge to two of the bedrooms need to be made safer to prevent risks of falls. All parts of the home need to be kept well repaired and decorated so that residents continue to live in a pleasant environment. Residents need to be provided with lockable bedroom doors with suitable facilities for staff to open them in an emergency. They also need lockable storage facilities in their rooms so that they can exercise a full choice about how much privacy they want. Whilst the residents interviewed indicated that they are mainly safe and well cared for by staff, formal systems for protecting them from abuse and harm need improvement. This is particularly relevant in relation to records of staff held by the home to prove that they are suitable to work with vulnerable older people. They were not all completed in every case. Records of their ongoing training and supervision also need to be available and clear, so that the person in charge of the home can ensure a suitable mix of skilled and less skilled staff when planning shifts. They are also necessary to ensure staff keep up-to-date with essential training to protect themselves and residents. At the moment slightly less than half the care staff are qualified to NVQ level 2 and this needs to be improved. Care staff would benefit from training in mental health care issues, not only in light of the home’s current registration, but to provide them with skills in recognising and assisting people with mental health care needs that may develop subsequently to their admission to the home. Written guidance to staff on the protection of vulnerable adults from abuse should be updated and senior care staff should attend local multi-agency training on this so that they are fully aware of the steps they need to take to ensure all residents are protected from abuse. Whilst most residents said they are satisfied with the care the home provides, the registered provider should more actively seek their views and provide them and their representatives with reports on the quality of the service. This is useful for prospective residents so that they can decide whether or not the home is suitable for them and to demonstrate the ongoing, planned improvement of the service in a way that continues to give residents the services they want. The registered provider needs to keep the Commission informed of progress on a regular basis, particularly in light of the extensive work that is being planned. A final recommendation is that residents, who wish it, are linked to a visiting library service so that they can obtain a variety of reading material, including books in large print and audiotapes. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chypons Version 1.10 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Chypons Version 1.10 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, & 5 Prospective residents have good information about the home to help them to decide whether or not it is suitable for them although some improvements are needed. New contracts need to be drawn up that provide residents with clear and fair statements of their terms and conditions. All residents are assessed before moving into the home but records of this need to be improved. The home does not admit people whose needs cannot be met there. Prospective residents and their relatives are encouraged to visit the home before moving in to see if it is suitable to meet their needs. The home does not provide intermediate care so this standard will not be assessed. EVIDENCE: The home’s Statement of Purpose has been updated and now contains information on fire safety to inform and reassure prospective residents and their relatives. The former registered manager has recently left and the Statement of Purpose needs to be updated to reflect this so that prospective residents have accurate information about the home. There is a separate service users’ guide and the person currently in charge of the home stated that these are given to all prospective residents. Copies are also available in the office. The registered provider is currently working on drawing up new
Chypons Version 1.10 Page 11 contracts and statements of terms and conditions for residents, which need to be completed so that they and their relatives are clear about their rights and responsibilities prior to their moving into the home. This is particularly relevant with regard to room changes for residents, which must only take place in accordance with their written contracts, in their best interests and with their permission. In situations where they lack capacity to make an informed decision they should be provided with an independent advocate to assist the decision making process. Some people expressed concerns about room changes that had been proposed for residents, in the course of the inspection, which were clarified with the registered provider and person in charge of the home. The person in charge of the home and the deputy manager assess all prospective residents in their own homes or current placements before they move into the home, regardless of whether they are assessed and funded by a professional agency or refer and fund themselves. There are documents on their files to support this but the current assessment format consists of impersonal, tick-box responses and does not provide any detailed or personcentred information. It does not provide evidence of a thorough assessment, which is necessary to inform staff and aid the subsequent care planning process. The inspector agreed to send the person in charge of the home a more detailed guidance note to assist them to improve practice. Residents who are referred by local health and social care agencies had copies of their joint health and social care plans on their files, which were clear and detailed. The person in charge of the home made sure that this information was sent to the home before a service user was admitted at the time of the inspection. Prospective residents and their relatives are encouraged to visit the home prior to being admitted and the statement of purpose confirms this. Staff have undergone training in caring for people with dementia but not on mental health issues. They would benefit from this to ensure that they can recognise and act appropriately to assist residents with mental health problems. In the meantime the home has good relations with external professionals from the local mental health partnership trust and ensures that residents with specialist needs continue to have the specialist support they require for as long as they need it. A professional employed by the Trust who was visiting the home confirmed this at the time of the inspection. Chypons Version 1.10 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Residents’ care plans set out most of their needs clearly but would be improved by full completion so that they and staff working with them are fully informed of their needs, preferences and views. Evidence that their healthcare needs are fully met needs to be improved. There has been considerable improvement in the home’s arrangements for managing residents’ medicines but further action is needed to ensure they are adequately protected from harm through medication errors. Residents are treated with respect but improvements to the home’s environment are needed to fully protect their safety and right to privacy. EVIDENCE: The home has an excellent care plan format, which provides for detailed and person-centred care planning. It includes consideration of residents’ religious and cultural needs, their hobbies, interests, food preferences and dietary needs and all other aspects of their health, personal and social needs. It includes actions and objectives to be achieved. There is also a personal profile for each resident so that staff working with them know more about them and can build up improved relationships with them as a result. These had not been completed for the residents whose care plans were seen at the inspection and it would be useful to do this. Residents and/ or their representatives should be
Chypons Version 1.10 Page 13 invited to sign their care plans to provide evidence of their participation in the care planning process and agreement with it. Care plans are regularly reviewed and updated and daily records maintained by care staff contribute to this. There are records of residents’ contact with a variety of healthcare practitioners but the medical history sections of their care plans should be fully completed to ensure that care staff working with them are fully informed about any healthcare needs they may need to be alert to. The registered provider has employed a chiropodist and a physiotherapist to come into the home on a regular basis, with no additional charges to residents. There are now improved activities for residents and most of those asked said they enjoy them or are satisfied with the level of activity provided for them. A pharmacist inspector from the Commission conducted a very detailed inspection of the home’s arrangements in respect of residents’ medicines at the last inspection of the home. Most of the detailed requirements set out in the pharmacist’s guidance letter to the home have been complied with so that residents are better protected by safe medicines practices and procedures. Staff handling residents’ medicines have now undertaken training in the safe handling of medicines at a local college. There are some outstanding tasks that need to be completed, however. None of the residents at this inspection was managing their own medication, nevertheless, their bedrooms need to have secure lockable storage space, not only for safety of future residents who may wish to manage their own medicines but also to enable current residents to lock personal belongings away should they wish to do so. This is particularly relevant in the absence of door locks on most of the bedroom doors. Most of the residents spoken to at the time of the inspection said they are satisfied with the arrangements for ensuring their privacy and dignity and there is a programme of extensive work to improve the physical environment of the home, which will significantly contribute to this in the future. The inspector saw evidence of work in progress and the registered provider has drawn up a written plan for this. The home caters for residents of both sexes and employs a mixed gender staff team. Residents are consulted on their preferences as to who works with them, particularly with regard to intimate personal care tasks and the person in charge of the home assured the inspector that their views are respected and acted upon. Chypons Version 1.10 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 13 The lifestyle offered in the home is well suited to meet the needs and preferences of most of the residents although one specific improvement should be followed up. The home welcomes visitors and encourages residents to maintain contact with their relatives and friends. EVIDENCE: The home’s statement of purpose provides information on the kinds of activities offered for residents and these have been re-introduced by staff. Their care plans consider their interests and hobbies, likes and dislikes and their cultural and religious needs. At the time of the inspection residents were occupying the lounge and dining room and socialising together. There was a quiz in the afternoon in the resident’s lounge and there were several visitors coming and going from the home. Other residents chose to remain in their rooms and this is respected although the manager tries to encourage them to come down to the dining room for main meals to meet and socialise with others. The registered provider is in the process of re-designing the hairdressing salon and this is nearly complete. He has also employed the services of a chiropodist and physiotherapist to come into the home on a regular basis. Most of the residents interviewed during the inspection stated that they are mainly satisfied with the activities provided. One said that they very much appreciate the musical entertainment, which has recently been
Chypons Version 1.10 Page 15 introduced. Another said that they enjoy the company of the other residents in the lounge and just enjoy watching the activities, even though they cannot always join in. The lounge and several of the bedrooms have spectacular views of the coastline and the home has a small paved patio and seating outside for residents who wish to go out. The inspector noted that while the home has a reasonable stock of books, there is no visiting library service and this should be introduced, if possible, so that residents can access a broader range of books, including those who require large print or talking books. Chypons Version 1.10 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 There are satisfactory systems in place to ensure that residents’ complaints are listened to and acted on. Arrangements to protect service users from abuse need to be improved to ensure their full protection. EVIDENCE: The home’s written complaints procedure is clearly posted in residents’ bedrooms and there is a comments book in the main hall so that they know how to make a formal complaint or comment about the home should they wish to do so. Most of the residents interviewed at the time of the inspection stated that they are satisfied with the care and services provided to them and several stated that staff are kind, caring and patient. The inspector noted that staff treated the residents respectfully at all times during the inspection. The home has written policies and procedures for the protection of vulnerable adults from abuse but these need to be updated and copies of the local multi-agency procedures should be obtained so that staff are fully aware of the actions they need to take should they suspect a resident has been abused. Senior staff should also attend local multi-agency training and cascade it to all staff working in the home. Records required by regulation for the protection of residents have now been obtained for all part-time and occasional workers but not for the person in charge of the home. Although there are two satisfactory references for her, these were obtained several months subsequently to her taking up employment in the home and other records needed to ensure the protection of residents are still needed. Not all the records needed to protect residents were available for some of the care staff. One staff member, who had started working at the home in 2003 only had one reference on their file and another recently recruited care staff member had not supplied a full
Chypons Version 1.10 Page 17 employment history on their application form. These records are needed so that the registered provider and the Commission can be confident that they are suitable to work with vulnerable adults. Chypons Version 1.10 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24, 25, 26 The home’s environment is safe and is in the process of undergoing major works to improve it for the welfare of the residents. Residents have a choice of communal facilities in and out of the home. Work is in progress to improve the home’s lavatory and washing facilities and the bedrooms are being redecorated as part of a rolling programme. The home’s surroundings are warm, comfortable and pleasant. The home is mainly clean and hygienic although work to improve the bathroom facilities and laundry flooring needs to be completed. EVIDENCE: The current registered provider has undertaken an extensive programme of work to upgrade and improve the physical environment throughout the home. Several bedrooms have already been redecorated and there are plans for this to happen on a rolling programme. This needs to include the provision of lockable storage space for residents in their own rooms and door locks that can be over-ridden by staff in an emergency to ensure that residents can choose to maintain their privacy in their private accommodation. The registered provider
Chypons Version 1.10 Page 19 has now supplied the Commission with a written maintenance plan but needs to continue to provide updates on a monthly basis so that progress can be monitored and time-scales for compliance reviewed if necessary. The hallway and main staircase to the building have been redecorated and fitted with new carpets and curtains. The hairdressing salon is being refurbished to provide an attractive environment away from the main lounge. The kitchen is being upgraded, with new steel worktops to provide a more hygienic setting for food preparation. The home’s storage facilities are being upgraded to save time for care staff so that they will have more time for direct interaction with residents. There are several outstanding requirements in respect of the home’s environment, particularly with regard to the provision of suitable toilet and washing facilities for residents and the need for a dedicated medicines treatment area but the registered provider is working to improve these in accordance with the timescales which have been previously set to reflect the extensive nature of work that is required to improve the home. In the meantime, all the residents currently in the home have comfortable, individual bedrooms, several with en suite bathrooms. Bedrooms are suitably furnished and residents can bring items of their own furniture if they wish, with the home’s agreement. There is a comfortable and homely lounge with dining area, a small patio and seating in the home’s grounds, which can be accessed by the stairs or lift and external ramp. The home was warm throughout at the time of the inspection. It is light and airy, with plenty of natural light and provides a pleasant, friendly atmosphere. The lounge and quieter communal spaces were in use by several residents throughout the inspection. Chypons Version 1.10 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 There are sufficient staff employed in a variety of capacities to meet residents’ personal care and other needs. Improvements are required with regard to record keeping in respect of the home’s recruitment practices and staff training for the protection of residents. EVIDENCE: The home’s staffing records and rotas indicate that there is a full-staff team and relatively low staff turnover in the home. Staff members interviewed at the time of the inspection confirmed this. There are day and waking night staff who are deployed in varying numbers to ensure that there are sufficient care staff to cover during busy periods. Non-care staff include cleaners, kitchen workers and a maintenance manager so that care staff are able to focus mainly on provision of direct care to residents. Most of the residents stated that they are satisfied with the home’s staff and several said that they are kind, caring and patient towards them. Not all the staff records required for the protection of residents were available in the home and these need to be obtained in every case. Records of interviews should be kept to provide evidence of fair, safe and effective recruitment and selection of staff who are suitable to work with vulnerable older people. Whilst there are some records of essential staff training it was difficult to determine who has had what training and it was clear that slightly less than the recommended 50 of care staff are currently qualified to NVQ level 2. Each member of staff should have a clear training and development plan and there should be an overall training plan for the home so that the person in charge can determine at a glance what training staff need and ensure a suitable skill mix of staff on duty, when drawing up rotas.
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The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 36 38 The home’s registered manager has resigned and a new manager, who is registered with the Commission as suitable to be in charge of the home needs to be appointed. Arrangements for ensuring that the home is run in the best interests of the residents need to be formalised and improved so that they and their representatives are kept fully informed. There are suitable systems in place to protect residents’ financial interests. Staff need to be appropriately supervised to ensure that they are properly meeting residents’ needs. There are systems in place to protect the health, safety and welfare of service users and staff although improvements are needed to the home’s environment to ensure their full protection. EVIDENCE: The registered provider is in the process of appointing a new manager for the home and two prospective managers were being interviewed during the course of the inspection. When an appointment is made they will need to apply to be
Chypons Version 1.10 Page 23 registered as manager with the Commission so that residents and their representatives can be confident that the person in day-to-day charge of the home is fit to do so and suitably qualified. In the interim the registered manager has appointed a temporary manager but full information to support their fitness to undertake this role was not available in the home at the time of the inspection. There is no formal system in place for determining the views of residents and their representatives on the quality of the services provided by the home and this needs to be set up. Residents and their representatives need to be informed of the outcomes so that they can be assured that their feelings and views are listened to and acted upon. The registered provider has submitted one report to the Commission on his review of the quality of the service based on an unannounced visit to the home during which he met with service users and staff members. This needs to continue on a monthly basis to support the necessary ongoing review of the quality of the service and inform the Commission of progress towards improving standards in the home. Notice of the announced inspection was posted on the home’s notice board and residents were provided with access to the inspector in private. Most of those interviewed in the course of the inspection expressed satisfaction with the care and services provided to them at the home. Most of the residents or their representatives manage their own financial affairs. Where small amounts of money are held for them by the home, there are secure storage facilities in place, money is held individually on their behalf and there are full records with receipts. Whilst staff are regularly supervised in the course of their ordinary work and there are records of structured induction training for new staff, there need to be records of regular staff meetings and 1:1 meetings between managers and care staff to ensure that they are provided with time to reflect on their work and consider how they can improve outcomes for service users. There are clear written safety procedures for residents and staff in respect of fire safety. The home has completed fire safety and environmental risk assessments, performed by external consultants. Staff training records need to be clearer so that the manager can determine their needs at a glance and ensure that they are kept up-to-date with regard to essential health and safety training. The home has records of fire safety training, checks and drills and records of other essential maintenance tasks. Chypons Version 1.10 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. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 1 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 2 3 2 x 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 1 x 2 x 3 1 x 2 Chypons Version 1.10 Page 25 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4(1) Requirement The homes statement of purpose must be amended to accurately reflect current management arrangements in the home. Service users must be provided with a clear and fair statement of the terms and conditions of their stay at the home, which ensures that they are not subject to room changes unless they or an independent advocate agree to them and such changes would be in the interests of their health and welfare. The medicines policy must be reviewed to ensure it is specifically applicable to this home. It must be signed with a two-year review date. It also needs to clearly state the managers responsibility for ordering prescriptions from the surgery and referencing bqack to the original repeat prescription. The GP must be asked to include full directions with specific areas to be treated, including eye(s) to be treated for eye preparations. The controlled drug cupboard fixed onto a wall must be fixed
Version 1.10 Timescale for action 01/08/05 2. 1&2 5(1) 12(1)(a) 12(2) 12(3) 01/08/05 3. 9 13(2) 01/08/05 4. 9 13(2) 01/08/05 5. 9 13(2) 01/08/04 Chypons Page 26 6. 9, 19 13(2) 7. 9, 10 & 24 12(4)(a) 8. 10, 21, 26 & 38 12(4)(a) 13(3) 23(2)(j) 9. 18, 29 & 31 17(2) 19(1) 10. 11. 12.
Chypons 19 19 & 38 19, 33 23(2)(b) 23(2)(d) 13(4)(a) 23(2)(o) 26 (1) 26(3) onto a solid wall with rag or rawl bolts to meet the Misuse of Drugs (Safe Custody) Regulations 1973. The physical design and layout of the building must be secure and dedicated for the purposes of safe handling of medicines. Service users must be provided with lockable bedroom doors with facilities for staff to override locks in emergency situations unless personal choice and risk assessments indicate otherwise. They must also be provided with lockable storage facilities in rooms for personal valuables and medication where they self-administer it. All service users must be provided with easy access to toilet facilities that are lockable and have hand-washing facilities Records required by reulation must be available for all persons working in the home, including two satisfactory references in every case, records of enhanced checks with the CRB and against the POVA register and full details of their employment history. This requirement is re-notified from 01/03/05 and further, in respect of the person currently in the home from 15/06/05. The timescale has been amended in light of recent management changes in the home to enable the registered provider to fully comply. All parts of the home must be kept reasonably decorated and in a good state of repair internally. Ramps leading off from two of the rooms need to be made safe to prevent risk of falls The registered provider must continue to provide reports to
Version 1.10 01/01/06 01/01/06 01/06/06 01/08/05 01/01/06 01/01/06 01/08/05
Page 27 26(4) 26(5) 13. 30, 38 18(1)(a) 18(1)(c) 14. 31 8(1) 15. 33 24(1) 24(2) 24(3) 16. 36 18(2) the Commission on a monthly basis in compliance with regulation 26 and particulary with regard to progress on improvement of the homes environemnt . There must be evidence that staff are provided with suitable training and deployed accordingly, through the development of clear, individual records of their training and development and a whole team training and development plan. The registered provider must appoint a registered manager to run the home on a day-to-day basis. A formal system for reviewing, monitoring and reporting on the quality of the care provided by the home to the Commission, service users and their representatives must be established. Care staff must be provided with formal suprervision with records kept. This should take place at least six times per year for each member of staff, pro rata for part-time staff. This requirement is re-notified from 01/03/05 and further, in respect of the person currently in the home from 15/06/05. The timescale has been amended in light of recent management changes in the home to enable the registered provider to fully comply once a suitable person has been appointed. 01/08/05 01/11/05 01/11/05 01/11/05 Chypons Version 1.10 Page 28 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 3&4 Good Practice Recommendations The homes assessment format should be person-centred and cover all the headings listed under standard 3.3 of the National Minimum Standards for Care Homes for Older People. Managers and staff working in the home should be given training in mental helath care for older people to ensure they have the knowledge and skills to provide for service users in accordance with the homes registration. Service users care plans should be completed in full, including their personal profiles, medical histories and all fields on the format. Where a field is considered not relevant, this should be made clear on the document. Service users and/or their representatives should sign care plans in every case. Where this is not possible, the reason should be stated in writing. Hand-written Mar charts should be checked by a second person and referenced back to the original prescription. Residents should be provided with access to a visiting library service. The homes written procedures for the protection of vulnerable adults from abuse should be updated to reflect current best practice. Copies of local multi-agency procedures for the protection of vulnerable adults from abuse should be obtained and provided to staff. Senior staff should attend local multi-agency training for the protection of vulnerable adults form abuse and cascade this to all staff working in the home. the laundry floor should be covered with impermeable, easily cleanable flooring Staff interview records should be retained in the home for inspection. 50 of the care staff should be qualified to NVQ level 2 or above. 2. 3&4 3. 7&8 4. 5. 6. 7. 8. 9. 10. 11. 9 12 18 18 18 19, 26 & 38 29 30 Chypons Version 1.10 Page 29 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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