CARE HOMES FOR OLDER PEOPLE
Chypons Clifton Hill Newlyn Penzance Cornwall TR18 5BU Lead Inspector
Lynda Kirtland Unannounced Inspection 21st March 2007 09:40 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.V334148.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.V334148.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.V334148.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 31st May 2006 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 is easily accessible by road. All the amenities 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. A team of care staff, including senior carers and ancillary staff including kitchen and cleaning staff and a maintenance manager provide care and support to service users. Fees range from £345.00-£475.00 per week, according to information supplied by the home’s manager on 12/05/06. Additional charges are made for hairdressing, newspapers and personal items. Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors visited Chypons for an unannounced key inspection on the 21 March 2007. It lasted for approximately seven hours. Information about the home received by the Commission since the previous inspection was taken into account when planning the inspection. 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 interviews with service users living in the home and visiting relatives and observation of the daily life and care provided. There was an inspection of the home’s premises and of written documents concerning the care and protection of service users and the ongoing management of the home. Staff were interviewed and observed in relation to their care practices and there was a discussion with the home’s prospective registered manager. Due to the number or statutory requirements identified at the previous inspection, the Commission focused on gaining an update as to how the management team are progressing towards compliance with the requirements identified. One method used was case tracking, of which three service users were selected. 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, indepth insight as to how residents’ needs are being met in the home. Whilst some outcomes for residents are 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 and the home’s prospective registered manager, who has been relatively recently appointed, to develop an action plan towards improvement. What the service does well:
Service users said that they have good access to healthcare services and the home actively promotes good health by encouraging them to attend keep fit sessions with a visiting physiotherapist. Service users said that activities are provided for them in accordance with their expectations and preferences and they are able to choose whether or not to join in. There was a calm, pleasant and restful atmosphere in the home and service users felt their visitors were welcomed to the home. Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 6 Although they were not sure about the formal procedures for making complaints, service users said that they would feel confident about taking any concerns they have to the home’s manager. Most of the service users said they were satisfied with the care and services provided to them and said that they had not felt the need to make formal complaints about the home. The home was comfortable, attractively furnished and decorated throughout and there have been ongoing improvements to upgrade and maintain the building so that residents benefit from a homely environment. Residents have spectacular views of the local coastline and the town from several private rooms and from the communal lounge. Residents said that there is sufficient staff to meet their needs. In addition to care staff, there are domestic, laundry, catering, office and maintenance staffs so that care staff have sufficient time to work directly with residents and spend time with them. The home manager ensures that relevant health and safety checks , such as fire equipment are maintained and regularly checked. What has improved since the last inspection?
Since the previous inspection the homes manager has complied with a number of statutory requirements and recommendations. They are as follows: The homes manager has ensured that all service users have received their contract of care. In addition a small lockable space has been installed in each service users private rooms so that they are able to securely store small items of value. A cordless telephone has been purchased so that service users can now make phone calls in private if they wish. The range of activities is now displayed so that service users can make a informed choice if they wish to participate in them or not. An artist and musician now visit the home expanding the range of activities on offer. The home manager is continuing to make community contacts with the churches and library in the hope that they will provide a visiting service to residents at the home. Service users stated that the food is ‘good’ and that there is a choice of main meal. Records of food are now being kept. The inspectors enjoyed a social lunch with service users in pleasant surroundings and found the food to be nutritious and enjoyable. The storage, administration and disposal of medication have improved thus allowing less opportunity for medication errors. The policy has also been reviewed but needs further amending to include the homes practice on the use of oxygen, insulin and homely remedies. Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 7 Staff have attended infection control training. The homes manager believes that staff morale has increased and this is reflected by the reduction in staff sickness in the home. The home manager has now introduced a questionnaire for service users to complete to gain their views on the services that the home provides. This is a confidential survey and the homes manager will send a copy of the outcome of this survey along with an action plan to the Commission when completed. The registered provider is now completing monthly Regulation 26 reports, which inform the Commission, and the home as to what progress the home is making. What they could do better:
Pre admission assessments must occur prior to a service user being admitted to the home so that the home can assess whether it is able to meet an individuals needs. This in turn will allow the prospective service user to form a view as to if they believe the home can cater for their needs and make an informed choice about living at the home. From files inspected there was no evidence of pre admission assessments taking place. The homes manager is reviewing the format of care plans. The current care plans do not inform, direct or guide staff as to the interventions needed to manage a particular element of care, therefore this could lead to inconsistent care practices, which in turn can be confusing for service users, especially those that experience confusion already. Individual risk assessments need to be developed further so that staff are aware of what actions they need to take in the event of example a fall. Risk assessments in the use of bed rails must be undertaken. The homes manager is currently addressing the need to promote privacy for service users in the home by reviewing the provision of locks on service users doors and in the toilet areas. The homes adult protection policy must be reviewed so that staff are aware of what action they need to take when an allegation or suspicion of abuse is brought to their attention. In addition staff must attend adult protection training and the homes management team must attend the Multi Agency Adult Protection training. Copies of the Multi Agency Adult Protection Procedures should be obtained and kept at the home. The recruitment of staff must be more robust. Form inspection of staff files it was evident that staff are employed before relevant CRB and POVA checks are approved. It was noted on the day of inspection that two newly recruited staff were on duty without these clearances. The consequence of this being that staff are not appropriately vetted and therefore could pose a risk when working with vulnerable adults. In addition it was observed that staff files do not have
Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 8 sufficient references and that staff qualifications are not present on files. A record of staff induction should be in place to ensure newly recruited staff are aware of the homes philosophy and policies. On the day of inspection a senior carer was covering for the home managers sickness, this meant that there was less carers to provide care to service users as she needed to undertake some management responsibilities. During the inspection the homes manager arrived at the home. This must be reviewed to ensure that sufficient staff are on duty at all times. The homes manager must apply to the Commission to be the Registered Manager of Chypons. She stated that her application is in process and will be forwarded to the Commission. Individual staff training profiles should be produced so that the homes manager is confident about the skills that her workforce has. A team-training programme would also benefit the home so that the homes manager can ensure that up to date and refresher training is carried out. Formal supervision of staff should be in place and recorded. It is noted that staff have attended the infection control course and the home was clean and tidy throughout. However staff were not using the appropriate protective clothing and therefore were posing a risk of cross infection to service users and staff in the home. The sluice room sacks were overflowing and need to be emptied more regularly. It was observed during the inspection that doors were wedged open. This is a fire hazard and must not continue. 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.V334148.R01.S.doc Version 5.2 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.V334148.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4, Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service users are provided with clear information about their terms and condition. There is no evidence that pre admission assessments have occurred, this must happen so that the home can ensure that they can meet the individuals’ needs. From this service users can then make a informed choice that they can be assured the home will be suitable to meet their needs. The home does not provide intermediate care so this standard was not assessed EVIDENCE: The homes manager has ensured that all service users have a copy of the homes revised standard contracts, which clearly set out the terms and conditions and fees. They are notified in writing, of annual fee increases, where they apply, so that they have good information about what is expected of them. From inspection of two recent admissions to the home, there were no pre admission assessments present and therefore there was limited information as
Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 11 to the care needs of a service user prior to and on admission. This means that for the Service users they are unable to make a informed choice as to whether or not the home will be able to meet their individual needs. The homes manager stated that as per the last inspection, some staff have undertaken training in caring for people with dementia, but not for people with mental illness, although the home has good relationships with local NHS healthcare providers and will obtain specialist support where necessary. Residents interviewed in the course of the inspection stated that they are well cared for and confirmed that they are assisted to access external healthcare services when they need them. Chypons DS0000055781.V334148.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a care plan format, which is currently being implemented. For the majority service users care needs are not clearly set out for them, or for care staff working with them and they are not regularly reviewed. There are satisfactory arrangements to ensure Service users have access to healthcare service. Some improvements have been made in the storage, administration and disposal of medication, but further improvements are needed. Some improvements to promote residents’ rights to privacy and dignity have been implemented. EVIDENCE: The homes manager is implementing a revised care plan and the format was discussed. The care plan will address service users personal, health and social care needs, including needs relating to their culture, religion, physical and sensory disabilities and personal relationships. However with the three service users case tracked this did not appear to be implemented and the care plans lacked detail and was unable to inform or guide staff in what interventions were needed to ensure consistent care practice is being provided for individual service users to manage their basic and more complex needs i.e. the management of depression or dementia.
Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 13 There was a lack of evidence of participation in the care planning process on the part of residents and/or their representatives in most cases and of recent reviews, to provide staff with clear and up-to-date written guidance on how residents need to be cared for. Service users told the Commission that they felt that in the main staff at the home met their care needs. All stated that they are confident about their ability to access external NHS healthcare services when they need them and staff will contact service users doctors on their behalf in response to specific needs. Documentation confirmed this. The home promotes good health and encourages Service users to keep fit and active by employing a physiotherapist to undertake individual and group work with them. Some improvements have occurred in the management of medication. The storage administration and disposal of medication was satisfactory. Inspection of MAR sheets demonstrated medication is administered appropriately. The prospective registered manager has revised the medication policy and ensured that the Royal Pharmaceutical Guide is in place. During the inspection it was noted that oxygen is in use, appropriate signage must be displayed where oxygen is in use or stored. The homes medication policy needs revision further to include the use of oxygen and homely remedies. Most of the service users interviewed stated that they are satisfied with the arrangements in place to ensure their privacy and dignity. They all stated that staff treats them kindly and with respect. Following the previous identified requirement in respect of service users having the opportunity to lock their bedroom doors, the homes manager stated this is being addressed. She has spoken with service users and identified who wish to have a lock on their bedroom door and risk assessments to ensure it is safe to do so are In the process of being completed. However there are difficulties in installing locks due to the door construction and new doors will need to be ordered to facilitate this. Changing of some toilet doors to allow a lock to be installed has the same difficulty and the prospective registered manager is looking at how this can be addressed i.e. change the door or purchase a sliding one with a lock attached to it. However the homes manager stated that small lockable storage facilities have been placed in each Service users room so that they can lock away small valuables if they wish. Service users can now make telephone calls in private if they wish as the home has purchased cordless phones that allow more privacy. Chypons DS0000055781.V334148.R01.S.doc Version 5.2 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. 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. Service users enjoy a good quality of life in the home with access to activities arranged by the home and in the community. They are encouraged to maintain contact with their families and friends and arrangements are in place in place for them to make decisions about things that are important to them. Service users confirmed they enjoy the nutritious meals provided by the home Action has been taken to improve the choice of food provided. EVIDENCE: Service users said that the activities provided in the home are appropriate for them in terms of what they expect and enjoy doing. Organised activities were displayed so that Service users could choose if they wish to participate or not. The homes manager is negotiating with churches and the libraries to expand the range of community activities visiting the home. Service users interests are recorded in their care plans. The home’s manager said that are no restrictions on visitors at reasonable times. Service users confirmed that their friends and relatives are able to visit them either in their own rooms or in the communal areas of the home. Service users said that they are able to make decisions about things that are important to them. They are able to personalise their private accommodation
Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 15 and bring items of furniture with them in agreement with the registered provider. Residents are expected to make their own financial arrangements and the home does not currently act as agent or appointee for any of them. The inspectors enjoyed a lunch with service users. This was an unrushed and social occasion in an attractive dining area with a pleasant atmosphere. Service users said they enjoyed the food and were given a choice of menu. Catering staff have attended healthy eating courses so that they are better informed about nutrition. Records of food served to residents are kept. The Commission observed care staff-entering and leaving the kitchen on numerous occasions that were not wearing protective clothing. At the time of inspection the dishwasher had broken down and the cook stated it was due to be repaired. Chypons DS0000055781.V334148.R01.S.doc Version 5.2 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. 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 home has satisfactory arrangements in place for residents to make complaints so that their concerns can be addressed. Improvements are needed to protect residents from harm and abuse. EVIDENCE: The majority of service users said that they were satisfied with the care and services provided to them and none had felt it necessary to make a formal complaint. They were unsure about the formal process, but said they would feel confident about taking any concerns to the home’s manager. Some did raise issues of minor concerns and were happy for the inspectors to raise these with the manager, when this was done she agreed to look in to the concerns immediately. The complaints policy needed a minor amendment to update it so that it refers to the Commission for Social Care Inspection. The home’s manager is in the process of updating the home’s internal procedures for the protection of vulnerable adults from abuse, which should guide staff on good practice. Copies of the local multi-agency procedures still need to be obtained and provided to staff so that they are aware of what action to take and which agencies to inform if they are concerned about the welfare and safety of a resident. All staff need training on protecting vulnerable people from abuse, so that they are fully aware of their responsibilities in this respect. The manager and senior care staff should attend multi-agency training so that they familiarise themselves with the ways in which different local agencies work together to protect vulnerable people.
Chypons DS0000055781.V334148.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is attractive, and comfortable so that residents enjoy a homely and well-maintained environment, although some improvements are needed so that they can more easily orientate themselves in the building. The home was clean and tidy at the time of the unannounced inspection but improvements are needed to ensure good hygiene is maintained so that residents are protected from infection risks. EVIDENCE: The home looks well decorated, attractively furnished and comfortable for Service users. There are continuous improvements being made to it to make it more attractive and safer for Service users and staff. Service users said that they were satisfied with the accommodation, including their private rooms. Service users, particularly those who are newly admitted or who have dementia related conditions would benefit from improved sign posting so that they can find their way about the home and more easily locate their bedrooms. Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 18 The home looked clean and tidy at the time of the unannounced inspection. Domestic staff are employed to keep it clean, so that care staff can focus on providing direct care to service users. Hygiene measures need improvement as it was observed throughout the inspection that staff were not wearing protective clothing even though it was available to them. The homes manager stated that this remains a problem, which she is attempting to address. Staff need suitable training so that service users are better protected from cross-infection risks. Some toilets, including the staff toilet did not have suitable hand washing materials, such as antibacterial soap and paper towels, for example, and the waste bag in the sluice room was overflowing. Chypons DS0000055781.V334148.R01.S.doc Version 5.2 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. 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. There are sufficient staffs, employed in a variety of capacities to meet residents’ needs, but an insufficient proportion of them have formal qualifications or the training they need to assure service users that they are skilled and competent to work with them. Recruitment policies and practices need considerable improvement so Service users can be sure that staff are suitable to work with vulnerable adults in a care setting EVIDENCE: Service users said that there was sufficient staff to provide Service users were complimentary about the skill and demonstrates. Some though commented that they understanding or communicating their needs with some staff their first language. them with care. care that staff have difficulty as English is not On arrival it was brought to the Commissions attention that the home was short staffed as the manager was on sick leave. However the prospective registered manager came into the home to participate in the inspection process, which was appreciated. On the day of inspection a senior carer plus 5 care staff where on duty that included 2 carers who were new employees and did not have the relevant POVA and CRB checks approved. Therefore they should not have been working in the home until these were granted. Staff are employed in a variety of capacities, with dedicated domestic, catering and maintenance staff so that care staff have sufficient time to work directly
Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 20 with service users. Interviews for the laundress were being held on the day of the inspection. Slightly less than the recommended proportion of care staff are qualified to NVQ level 2 or above, although the home’s manager stated that several are working towards achieving qualifications. The manager said that staff have attended a infection control course. Examination of recruitment records showed that recruitment practises are insufficiently robust to ensure that staff are recruited fairly and on the basis that they are suitable to work with vulnerable people in a care setting. There was a lack of completed application forms, interview records, evidence of checks conducted with the Criminal Records Bureau and references on staff files inspected. The home’s manager said that she has arranged some training for staff, including basic food hygiene training for catering staff, for example, but staff do not have individual training plans and there is no training plan for the staff team as a whole so that training needs can be identified, prioritised and met. There was a lack of evidence of staff training and qualifications on their files or assurances from staff working in the home that they regularly undertake training so that they have the necessary skills and competences to work effectively with residents. New staff said that their induction training consisted of working alongside more experienced staff, but there were no records of formal induction training. Chypons DS0000055781.V334148.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): 31,33,36,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s manager is in the process of completing their application to be registered with the Commission so that Service users can be assured that the home is managed competently. Some progress has been made towards developing a system to review the quality of care provided so that Service users can be assured that the home is managed in their best interests, although more needs to be done on this. Service users financial interests are managed so that they retain control and independence in relation to their personal finances. Improvements are needed so that Service users can be confident that staff working with them is properly supervised and improvements are needed to ensure that they are protected from avoidable risks. EVIDENCE: Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 22 The home’s manager said that she is in the process of completing her application to be registered with the Commission. Staff and most Service users said that they felt that the home is well managed. Some progress has been made to consult with Service users formally about the services the home provides. A questionnaire has been sent and the homes manager is awaiting the responses. The registered provider has sent regular reports about the conduct and management of the home that he is required to do so that Service users can be assured that the home is being managed in their best interest. There is a lack of evidence that care staff receive formal supervision beyond working alongside a more experienced member of staff and no records are kept, although staff said that they felt adequately supported in their work. There was evidence that safety, including fire safety equipment is regularly checked and tested by competent professionals and the building is well secured at night to protect residents from intruders, with a video entry system and secure locks. The fire safety risk assessment has been reviewed and the homes manager said that this has been approved by the fire authority recently. Individual risk assessments of service users need to be developed further and incorporated in their care planning process, with particular regard to those who are at risk of falls, the use of bed rails and environmental risks. Chypons DS0000055781.V334148.R01.S.doc Version 5.2 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 3 1 1 N/A x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 X X X 1 X 2 Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? no 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)(a) Requirement Pre admission assessments must occur to ensure that the home can meet Service users care needs and assist the Service users in making a informed choice as to whether they feel the home can meet their needs. The registered provider must ensure that all Service users are provided with clear written care plans to show how their health and social care needs are to be met. These must be drawn up in consultation with them or their representatives, kept under review and updated as their needs change. This is re notified to you, original timescale for compliance was 01/08/06 The medicines policy must be amended further to include the use of oxygen and insulin. Service users must be provided with lockable bedroom doors with facilities for staff to override locks in an emergency
DS0000055781.V334148.R01.S.doc Timescale for action 01/07/07 2. OP7 15(1)15(2 ) 01/06/07 .3. OP9 13(2) 01/07/07 4. OP10 12(4)(a) 01/06/07 Chypons Version 5.2 Page 25 unless personal choice and risk assessments indicate otherwise. This is re notified to you, original timescale for compliance was 01/01/07 5 OP10 12(4)(a) All toilets and bathrooms must be provided with lockable doors with facilities for staff to override them in an emergency. This is re notified to you, original timescale for compliance was 01/01/07 The registered provider must consult with residents and ensure that those who wish to have door lock fitted to their bedroom doors are prioritised and provided with them. This is re notified to you, original timescale for compliance was 01/08/06 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, 01/07/06. A further date was set at the previous inspection 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
DS0000055781.V334148.R01.S.doc 01/06/07 6 OP10 12(4)(a) 01/06/07 7 OP18 17(2) 19(1) 01/06/07 8 OP18 13(6) 01/06/07 Chypons Version 5.2 Page 26 and provision of up-to-date written procedures, which reflect local multi-agency agreements. This is re notified to you, original timescale for compliance was 01/07/06 9 OP26 13(3) Staff must use the relevant protective equipment to minimise the risk of cross contamination and promote infection control in the home. The registered provider must ensure that full records are retained in respect of all staff employed to work in the home, including records set out in schedules 2 and 4 of the regulations. This is re notified to you, original timescale for compliance was 01/08/06 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. This requirement has been renotified on two previous occasions with dates set for compliance by 01/08/05 and 01/02/06 and 01/07/06. A further date was set at the previous inspection in light of management changes in the home. 01/07/07 10 OP29 17(1)17(2 )19 (1) 01/06/07 .11 OP30 18(1) 01/07/07 .12 OP30 17(2)18(1 )(c) The registered provider must 01/07/07 ensure that induction records are maintained for all new staff employed to work in the home. Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 27 13 OP31 8(1) The registered manager must 01/06/07 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 and 01/07/06 and 01/08/06. A further date was set at the previous inspection in light of management changes in the home. 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 and 01/07/06. A further date was set at the previous inspection in light of management changes in the home. 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 and 01/07/06. A further date was set at the previous inspection in light of management changes in the home. The registered provider must ensure that risk assessments in respect of individual service users are regularly reviewed and
DS0000055781.V334148.R01.S.doc 14 OP33 24 01/06/07 15 OP36 18(2) 01/06/07 16 OP38 13(4) 01/06/07 Chypons Version 5.2 Page 28 17 OP38 23 (4) updated. This is re notified to you, original timescale for compliance was 01/08/06 Doors must not be wedged open as this can pose a health and safety risk, especially in terms of fire to all at the home. 01/04/07 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 OP3 Good Practice Recommendations 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. 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. 2 OP3 3 OP4 4 OP7 5 OP9 6 OP12 Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 29 7 OP12 Service users’ religious and cultural needs should be fully considered in assessment and care plann9ing to ensure that the home will be able to meet them. 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. Sign posting should be improved so that residents can easily locate different areas of the home and their individual rooms. All staff handling food should undergo training in basic food hygiene. The waste bag in the sluice room should be regularly emptied, particularly when it is full. At least 50 of the Care Staff should be qualified to a minimum of NVQ level 2. There should be a risk assessment and risk management plan put into place to ensure the safety and welfare of service users who are in the lounge, without access to call bells. 8 OP18 9 OP18 10 OP18 11 OP19 12 OP26 13 14 15 OP26 OP28 OP38 Chypons DS0000055781.V334148.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South Devon Area Office Unit D1, Linhay Business Park Ashburton Devon 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
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