CARE HOMES FOR OLDER PEOPLE
Chypons Clifton Hill Newlyn Penzance Cornwall TR18 5BU Lead Inspector
Lowenna Harty Unannounced Inspection 21st March 2006 10:00 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.V286483.R01.S.doc Version 5.1 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.V286483.R01.S.doc Version 5.1 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.V286483.R01.S.doc Version 5.1 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 16th June 2005 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, is easily accessible by road and within close proximity of local amenities such as shops and public transport, although there is quite a steep hill leading up to the home. There is car parking space for visitors in the home’s grounds. The home is set in its own grounds and consists of two inter-linked wings. Most of the bedrooms provide single accommodation 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 salon. There is a small paved terrace area on the upper floor so that residents can sit outside if they wish. The home has a lift so that residents can access the upper floor and the entrance to the building has suitable access for people with physical disabilities. There is equipment, including grab rails at strategic points to assist people with physical disabilities. The home is privately owned and the registered provider employs a manager to run it on a day-to-day basis. A team of senior carers, care staff and ancillary staff assist them. Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on 26 March 2006 and was unannounced. It started in the morning, after breakfast and lasted for approximately five hours. The purpose of the inspection was to ensure that residents’ needs are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved looking at documents written for them and about them, and examination of the home’s written policies, procedures and records kept to ensure the welfare and protection of residents living there. It involved an inspection of the home’s premises, interviews with residents and observation of the daily life of the home. Time was spent discussing the management of the home with the registered provider and acting manager. The principle method used was case tracking. This involves examining the care notes and documents for a select number of residents and following this through with interviews with them or their relatives and staff working with them. This provides a useful, in-depth insight as to how residents’ needs are being met in the home. At this inspection, two residents were case tracked and a total for six residents were interviewed, in private. Whilst outcomes for residents are generally good, there are a number of outstanding requirements from previous inspections, which the registered provider needs to comply with to protect residents’ best interests. The Commission is working with the provider to develop an action plan towards improvement. On the day of the inspection, there was a new acting manager in charge of the home as a result of the sudden departure of the previous one. Outstanding requirements have been re-issued in light of this. What the service does well:
The home is registered to provide for some people with dementia. Approximately half the current team of care staff, including the home’s acting manager, have undertaken training so that they can better meet their special needs. Most of the residents who were interviewed at the time of the inspection said that they are satisfied with the care and services provided to them, including arrangements to maintain their privacy.
Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 6 Most of the residents who were interviewed said that they are very satisfied with the food provided to them. They are able to choose to either have their meals served to them in their own rooms, or to dine in the home’s attractive main dining room, which adjoins the lounge. All of the residents in the home said that they feel safe there and most said that they are satisfied with the care provided to them by the staff. Visitors are welcome and there are plenty of people coming and going from the home so residents are not isolated. The home provides residents with a pleasant and restful environment. It is well furnished and comfortable and is being continuously improved. Most of the home’s staff are qualified or working towards achieving formal qualifications so that residents can have confidence that they are competent to work with them. The current acting manager is very experienced in working at the home. There is enough information about her in the home to provide evidence that she is fit to be employed in her current capacity and she is in the process of applying to be registered with the Commission. There are suitable financial systems in place to ensure the smooth running of the business and that resident’s day-to-day needs are met. What has improved since the last inspection?
A revised statement of the terms and conditions/ contract has been introduced, so that residents will be clearer about their rights and responsibilities in the future. There is an ongoing programme to improve the home’s environment and this was evident at the time of the inspection. Several rooms have been refurbished since the previous inspection and the home is well furnished and well decorated for residents. Telephones have been installed at strategic points about the building so that staff can summon assistance quickly if they need it. Specific improvements needed to make the home safer have been completed. Residents’ personal records are now safely stored on the premises and not taken away from the home so that they can be confident that personal information about them will be kept private and secure.
Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 7 There have been vital improvements to the home’s fire alarms and emergency lighting systems to protect residents from the risks of injury as a result of fire in the home. What they could do better:
The new contract needs to be implemented so that residents now and in the future are clear about their rights and responsibilities. Assessments for new residents should consider all of their personal, health and social care needs, including their needs in relation to their background, religion and culture, so that they and the home’s staff can be sure that the home will be suitable for them. Residents should be invited to sign their assessments to show that they agree with the information that is recorded about them. The home is registered to provide for older people with mental health care needs. Staff should undertake training so that they can meet their specialist needs more effectively. Resident’s should be provided with clear, written care plans, which they agree with, so that staff have sufficient guidance to provide them with care in accordance with their individual needs and wishes. Their care plans should fully address their needs, including those relating to their background, religion and culture. The home’s environment should be improved so that residents are able to exercise a greater degree of choice about the level of privacy they wish to enjoy. This includes provision of door locks on all bedrooms and bathrooms and lockable storage space in bedrooms so that residents can safely store items of personal value or medicines, should they choose to manage them for themselves. Menu plans should list an alternative for every meal so that residents are able to exercise a greater degree of choice. Individual records of food provided to them should be maintained so that their nutritional needs can be monitored. Formal systems to protect residents from abuse need to be improved so that they are better protected. This includes ensuring that there are suitable checks on staff working in the home, providing staff with training on what to do if they suspect abuse and making sure they read and understand the procedures on what to do, and follow them. Systems to ensure good hygiene in the home need to be improved so that residents are protected from the risk of infection as far as is possible. This
Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 8 includes provision of suitable hand washing facilities in all the bathrooms, easily cleanable flooring in the laundry and training in infection control for all staff. Staff should be employed fairly and according to their suitability to work in a care setting. This is important to ensure the welfare and protection of residents and maintain the good standing of the business. There should be clear records of what training they have and what training they need, so that the home’s manager can plan staff training and ensure there is a suitable combination of trained staff on duty at all times to be able to meet residents’ needs. There need to be improved systems to consult with residents and their representatives on the quality of care provided in the home. The registered provider needs to report on the state of the home to the Commission every month, particularly while the home’s management is undergoing change. This is important to ensure that the home is run in the best interests of the service users. Staff supervision systems need to be improved so that residents can be confident that the people looking after them are well monitored and supported in their work. The home’s manager should review the fire safety risk assessment and make sure that fire safety records are readily accessible at all times so that she can be fully confident that residents are safe in the home. 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. Chypons DS0000055781.V286483.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Chypons DS0000055781.V286483.R01.S.doc Version 5.1 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 the following standard(s): 2, 3 & 4 New contracts for service users have been drawn up, but still need to be implemented so that they have clear and fair statements of the terms and conditions of their placements in the home. Service users should participate in the assessment process, which should fully consider their needs so that they can be confident the home will be suitable for them. Staff should be trained so that they can effectively meet service users’ specialist needs in accordance with the home’s registration. EVIDENCE: There are copies of a new contract for service users, with clear statements of their terms and conditions, attached to service users’ guides for the home. Contracts clearly state that service users will not be subject to room changes without their consent and/ or the agreement of an independent representative. These contracts have not yet been implemented and need to be. There continues to be a lack of clear assessment documentation, distinct from care planning, which fully addresses service users’ personal, health and social care needs in line with the National Minimum Standards, including needs
Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 11 relating to their background, religion and culture. Assessment documentation for the most recently admitted service user was not signed by them or their representative to indicate their participation in and agreement with the information. The home’s acting manager and approximately half the members of the current staff team have undertaken training in caring for people with dementia, via a local college, although some are still awaiting certificates to confirm their attendance. Training in caring for older people with mental health care needs still needs to be arranged. Chypons DS0000055781.V286483.R01.S.doc Version 5.1 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 the following standard(s): 7, 9 & 10 Service users need clear care plans to fully address their personal, health and social care needs, including needs relating to their background, religion and culture, which they participate in drawing up and are regularly reviewed. Specific improvements are needed to protect service users from risks associated with medication errors. Improvements are needed to provide service users with a greater degree of choice as to the level of privacy they wish to enjoy. EVIDENCE: There are several different care plan formats in operation currently which, based on those inspected, lack of a clear differentiation between assessment and care planning with the result that staff lack clear direction on how service users’ needs should be met. There is also a lack of evidence of regular, ongoing reviews of service users’ needs and participation by service users in the care planning process. Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 13 Only staff who are trained in the safe handling of medicines assist service users with their medication. There are safe facilities for storage and the administration of medicines, but the written policies and procedures to guide staff need to be updated and amended so that they reflect good practice for this particular home. Handwritten entries on service users’ medication charts should be counter-signed and referenced back to the original prescription to protect service users from medication errors. Most of the service users who were interviewed stated that they are satisfied with the care the home provides, including arrangements for maintaining their privacy but physical improvements to the home’s environment are needed to ensure that they are fully able to choose the level of privacy they wish to enjoy. All bathrooms and toilet doors need to be lockable, including one, which is currently in frequent use and is only served by a curtain. Service users must be provided with lockable storage space in their bedrooms, particularly pending the planned provision of lockable doors with safety over-rides for staff for all of the bedrooms. This is also necessary to enable them to safely manage their own medication, should they be able and wish to do so. Chypons DS0000055781.V286483.R01.S.doc Version 5.1 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 the following standard(s): 12, & 15 Some improvements are needed to ensure that service users’ cultural and religious needs are fully recognised and met. Specific improvements are needed to ensure that all service users receive a nutritional, balanced diet, which is acceptable to them. EVIDENCE: Most of the service users who were interviewed were satisfied with the activities provided to them although they should be provided with visiting library services if these can be arranged. There are records of service users’ likes and dislikes and preferences with regard to activities, but there needs to be more consideration of their religious and cultural needs as part of their assessment and care planning to ensure that they can be met. Most of the service users who were interviewed at the time of the inspection stated that they are very satisfied with the meals provided to them at the home. They are able to choose whether or not to have their meals served in their bedrooms or in the home’s attractive dining room. There is a four weekly menu, but there is not always a choice recorded for every meal and individual records need to indicate whether or not service users have received satisfactory levels of nutrition.
Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 15 Chypons DS0000055781.V286483.R01.S.doc Version 5.1 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 the following standard(s): 18 Systems to protect service users from abuse need to be improved. EVIDENCE: All of the service users confirmed that they feel safe in the home and most were satisfied with the care they receive but formal systems to protect them form abuse need to be improved. This includes staff training, written procedures to guide them on what to do should they suspect abuse of a service user and maintenance of records about staff to demonstrate that they are safe to work with vulnerable people in a care setting. Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 19, 21 & 26 The home is well maintained with an ongoing improvement plan in place. There are sufficient numbers of lavatories and washing facilities to meet service users’ needs. Improvements are needed to ensure good hygiene in the home. EVIDENCE: There is evidence of ongoing maintenance of the home as part of a plan to improve the home’s environment. At the time of the inspection external maintenance engineers were in attendance and there is a maintenance manager on the staff team. Steps leading to some of the bedrooms from the main lounge have now been made safe and the home is comfortably furnished and well decorated throughout. Several of the bedrooms have been refurbished as they have become vacant. Telephones have been installed at strategic points around the home so that staff working in situations away from the main office can summon assistance quickly, if they need it. There are sufficient numbers of toilets and bathrooms in the home to meet service users’ needs and most of the bedrooms have en suite toilets.
Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 18 Improvements are needed to ensure good hygiene in the home, including replacement of the laundry floor with an easily cleanable surface, provision of suitable facilities to encourage good hand washing in all of the service users’ toilets and suitable training in infection control for all staff. Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 There are sufficient numbers of qualified staff who are deployed to ensure that service users are in safe hands at all times. There needs to be evidence that staff are recruited on the basis of fair, safe and effective recruitment policies and practices and are suitable to be employed in a care setting. There is a lack of evidence that staff are trained and competent to do their jobs. EVIDENCE: Records of staff on duty show that there are qualified staff available to support service users at most times of the day and night. Most of the care staff either have or are working towards completing qualifications to at least NVQ level 2 in care. A written procedure for staff recruitment needs to be developed, to back up good practice. Recruitment needs to be demonstrably fair, with records of selection procedures and interviews retained. It needs to be safe in that checks are made to ensure that staff are suitable to work with service users in a care setting and effective in that staff are selected on the basis of their competence to meet service users’ needs and suitability, with records to back this up.
Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 20 Evidence that staff are trained and have regular training updates so that they can work safely, skilfully and effectively with service users needs to be improved. There should be a whole team staff training plan in place, so that training needs can be readily identified and prioritised for the protection and welfare of the service users. Chypons DS0000055781.V286483.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 36, 37 & 38 The home’s acting manager is in the process of making an application to be registered with the Commission. In the meantime there is sufficient evidence to demonstrate their suitability to undertake this role. Formal quality assurance systems need to be set up to demonstrate that the home is run in the best interests of the service users. The home’s accounting and financial systems ensure that service users needs are met. Formal systems for supervising staff need to be set up so that their skills and competence to work with service users are monitored on an ongoing basis. Records relating to the business are now retained securely in the home, so that service users’ confidentiality is maintained. The home is safer now for service users and staff, but further specific improvements are needed.
Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 22 EVIDENCE: There has been a recent change in the acting manager arrangements and the previous manager had very recently departed, at the time of the inspection. The new acting manager is experienced in working at the home and was previously employed as a senior carer. She is qualified to NVQ level 3 and is undertaking training to achieve NVQ level 4 in management. There is no formal quality assurance procedure in place. There was a comments book in the past, but this was not well used and was located in the office at the time of the inspection. The registered provider regularly visits the home, but needs to submit formal reports to the Commission on the state of the business on a monthly basis, with sufficient detail to provide assurances that the home is in safe hands. An accountant is employed to work at the home to assist the acting manager with the office work. The acting manager confirmed that there is sufficient cash flow to provide for service users’ day-to-day needs and there is evidence of investment to secure ongoing improvements to the home’s physical environment. The home has sufficient insurance cover in place with a certificate displayed in the office. Improvements have been made to record storage and records relating to the business, so that service users can be assured that their confidences will be maintained. The acting manager confirmed that residents’ personal care records are kept safely in the home. There is a lockable office and sufficient storage space for them. Improvements have been made to the home’s fire alarm and emergency lighting systems to make them safe. The acting manager should review the home’s fire safety risk assessment and ensure that she is able to access the home’s fire safety records, including alarm and equipment test records at all times. At the time of the inspection she was unable to locate them, because the home’s maintenance manager was not on duty. Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 23 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 X 2 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 3 X 3 X X X X 1 STAFFING Standard No Score 27 X 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 3 X 1 3 2 Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 24 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 OP9 Regulation 13(2) Requirement The medicines policy must be reviewed to ensure it is specifically applicable to this home. This requirement has been re-notified on two previous occasions, with compliance dates set for 01/09/05 and 01/02/06. A further date has been set in light of recent changes in the management structure of the home. Service users must be provided with lockable bedroom doors with facilities for staff to override locks in an emergency unless personal choice and risk assessments indicate otherwise. Service users must be provided with lockable storage facilities in their rooms for personal valuables and medicines unless their personal choice and risk assessments indicate otherwise. This requirement has been renotified, with compliance previously set for 01/02/06. A further date has been set in light of recent changes in the management structure of the home.
DS0000055781.V286483.R01.S.doc Timescale for action 01/07/06 2. OP10 12(4)(a) 01/01/07 3. OP10 12(4)(a) 01/07/06 Chypons Version 5.1 Page 25 4. OP10 12(4)(a) 5. 6. OP15 OP18 17(2) 17(2) 19(1) 7. OP18 13(6) 8. OP26 13(3) 9. OP26 13(3) 10. OP30 18(1) All toilets and bathrooms must be provided with lockable doors with facilities for staff to override them in an emergency. Records of food provided to individual service users must be maintained. Records required by regulation 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 with full details of their employment history. This requirement has been re-notified on five previous occasions with dates set for compliance by 01/03/05, 15/06/05, 01/08/05, 01/11/05, and 18/11/05. A further date has been set in light of management changes in the home. There must be safe and sound systems in place to protect service users from harm and abuse, including staff training and provision of up-to-date written procedures, which reflect local multi-agency agreements. There must be suitable systems in place to protect staff and service users from infection risks. The registered provider must ensure that staff are suitably trained in infection control and that this is kept up-to-date. This requirement is re-notified with a previous date set for compliance by 01/02/06. A further date has been set in light of management changes in the home. There must be evidence that staff are provided with suitable training and deployed accordingly, through the development of clear, individual
DS0000055781.V286483.R01.S.doc 01/01/07 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 Chypons Version 5.1 Page 26 11. OP31 8(1) 12. OP33 24 13. OP33 26 records of their training and development and a whole team training and development plan. This requirement has been renotified on two previous occasions with dates set for compliance by 01/08/05 and 01/02/06. A further date has been set in light of management changes in the home. The registered manager must appoint a registered manager to manage the home on a day-today basis. This requirement has been re-notified on two previous occasions with dates set for compliance by 01/08/05 and 01/02/06. A further date has been set in light of management changes in the home, which sere beyond the control of the registered provider. 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. This requirement has been re-notified with a previous date set for compliance by 01/02/06. A further date has been set in light of management changes in the home. The registered provider must submit reports to the Commission on a monthly basis in compliance with regulation 26. This requirement has been renotified with a previous date for compliance by 30/11/05. It is of concern to the Commission that the registered provider has continued to fail to provide these reports on a regular basis, particularly in light of the recent changes in the management of t he home. Reports are due from
DS0000055781.V286483.R01.S.doc 01/07/06 01/07/06 01/07/06 Chypons Version 5.1 Page 27 14. OP36 18(2) 01/12/05. Care staff must be provided with formal supervision with records kept. This requirement has been re-notified on four previous occasions with dates for compliance by 01/03/05, 15/06/05, 01/11/05 and 01/02/06. A further date has been set in light of management changes in the home. 01/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP2 OP3 OP3 OP4 Good Practice Recommendations The revised service user contracts/ statements of terms and conditions should be implemented for all service users. The home’s assessment format should address all the headings listed under standard 3.3 of the National Minimum Standards for care homes for older people. Service users and/or their representatives should sign their assessments as evidence of their participation and agreement with them. Staff working in the home should be given training in mental health care for older people to ensure they have the knowledge and skills to provide care for service users in accordance with the home’s registration. A single, clear format for care planning should be introduced for all service users. This should fully address their personal, health and social care needs, as set out in standard 3.3 and be reviewed at least monthly. Service users and/or their representatives should sign their care plans as evidence of their participation and agreement with them. Hand written MAR charts should be checked by a second person and referenced back to the original prescription. Service users should be provided with access to a visiting library service. Service users’ religious and cultural needs should be fully
DS0000055781.V286483.R01.S.doc Version 5.1 Page 28 5. OP7 6. 7. 8. 9.
Chypons OP7 OP9 OP12 OP12 10. 11. OP15 OP18 12. 13. 14. 15. 16. 17. 18. 19. OP18 OP18 OP26 OP26 OP26 OP29 OP29 OP33 20. 21. OP38 OP38 considered in assessment and care plann9ing to ensure that the home will be able to meet them. Service user should be provided with a choice of meals at each main meal. The home’s manager and senior staff should attend local multi-agency training for the protection of vulnerable adults from abuse and cascade this to all staff working in the home. The home’s written procedures for the protection of vulnerable adults from abuse should be updated to reflect best practice and be specific to this home. Copies of local multi-agency procedures for the protection of vulnerable adults from abuse should be obtained and provided to all staff working in the home. The laundry floor should be covered with impermeable, easily cleanable flooring. All toilets should have paper towels and anti-bacterial soap at all times. All staff should undergo training in infection control. All staff handling food should undergo training in basic food hygiene. Staff should be employed on the basis of fair, safe and effective recruitment policies and practices. Staff selection and interview records should be retained in the home for inspection. Reports by the registered provider based on his monthly visits should provide the home’s manager and the Commission with reasonably detailed information on how the home is being conducted. The acting manager should review the home’s fire safety risk assessment. Fire safety test records should be available to the home’s manager at all times. Chypons DS0000055781.V286483.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection St Austell Office 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
© 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.V286483.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
