CARE HOMES FOR OLDER PEOPLE
Chypons Clifton Hill Newlyn Penzance Cornwall TR18 5BU Lead Inspector
Lowenna Harty Unannounced Inspection 31st May 2006 09:45 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.V298384.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.V298384.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.V298384.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Service users to include up to 27 adults of old age (OP) Service users to include up to 3 adults with dementia (DE) [E] Service users to include up to 3 adults with a mental illness (MD) [E] Total number of service users not to exceed a maximum of 27 Date of last inspection 21st March 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.V298384.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an annual key inspection took place on 31 May 2006 and was unannounced. 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 residents living in the home and visiting relatives and observation of the daily life and care provided. Interviews were conducted in private with residents, some in their own rooms and some in the lounge. There was an inspection of the home’s premises and of written documents concerning the care and protection of the 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 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, four residents were case tracked. 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 manager, who has been relatively recently appointed, to develop an action plan towards improvement. What the service does well:
The home has a standard contract, which sets out the terms and conditions for residents and provides them with clear information on fees, so that they know what will be expected of them if they choose to stay in the home. They are informed in writing about annual fee increases. Most residents are assessed prior to their admission and some of the staff team have undertaken training in caring for people with dementia so that they will be able to meet residents’ needs effectively. Residents and relatives interviewed at the time of the inspection 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. Residents, who had attended a session on the day of the inspection, said that they appreciated this service. Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 6 Residents 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 visitors said that they are made to feel welcome. One resident likes to help out with small tasks in the home and this is encouraged and supported so that they can retain their skills and independence. Some residents said that food provided is “excellent” and they are able to choose to take meals either in their own rooms or in the home’s pleasantly set up dining room. There is a regularly changed menu and residents are provided with a choice of food at each meal. Although they were not sure about the formal procedures for making complaints, residents said that they would feel confident about taking any concerns they have to the home’s manager. Visiting relatives confirmed this. Most of the residents interviewed 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 are sufficient staff to meet their needs and this was evident at the time of the inspection. In addition to care staff, there are domestic, laundry, catering, office and maintenance staff so that care staff have sufficient time to work directly with residents and spend time with them. Most residents and staff interviewed said that they felt the home is well managed. There are good security systems in place to protect them from intruders and key safety equipment, including fire safety equipment is regularly checked to make sure the home is kept safe for residents, visitors and staff. What has improved since the last inspection?
The manager has now introduced a new care plan format, which when implemented, should ensure that residents needs are fully considered and agreed with them. Residents were being consulted about the quality of the food provided to them at the time of the inspection, with a view to introducing improvements in the future so that more of them enjoy their meals in the home. Catering staff have undertaken training in healthy eating recently, so that they are better informed about residents’ nutritional needs. The laundry flooring has now been replaced so that it is more hygienic and the clock in the dining room has been replaced so that it now tells the correct time.
Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 7 This is important, particularly for people who may have moments of confusion and rely on correct information for reassurance. The home looked clean and tidy throughout at the time of the unannounced inspection and residents remarked on its cleanliness. There are dedicated domestic staff employed to keep it clean, so that care staff are able to focus on providing direct care. The registered provider’s most recent monthly report to the Commission on the conduct and management of the home was more detailed and informative and showed that he had directly asked residents about the quality of the services provided, so that they could be more assured that the home is being well managed, in their best interests. What they could do better:
Not all new residents had written contracts and some were unclear about the terms and conditions of their placements in the home. All residents and/or their representatives need to be given clear and fair information so that they can make an informed choice about whether it is suitable for them. Assessment information for some residents continues to lack sufficient detail to enable staff to effectively plan their care or be sure that the home will be suitable to meet their needs. Some of the residents who were interviewed were unclear about their admission process and choice of home although they demonstrated a clear capacity to make choices and decisions in other ways. The home is registered to admit some residents who have mental health care needs and this is relevant for some residents currently in the home. Care staff should be provided with training in this respect so that they are better informed about their specialist needs. Residents are not sufficiently involved in or aware of their care plans, which set out how staff are to meet their health, personal and social care needs. The written records reviewed at the inspection were incomplete and out of date so care staff did not have clear written guidance to refer to in respect of individual residents. Written instruction for care staff administering medicines and actual recording and storage systems need to be improved so that residents are protected from medication errors, when staff manage their medicines on their behalf. Some residents said that they would prefer to be provided with lockable bedroom doors so that they can feel safe and secure in the home at night. At present, residents do not have locks or lockable storage space in their bedrooms so they cannot choose the level of privacy they wish to enjoy. They
Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 8 also said that they did not feel confident that they would be able to make telephone calls in private. Communal bathrooms and toilets do not all have lockable doors and the toilet most in use, because of its proximity to the dining room, only has a curtain, which does not provide adequately for residents’ privacy or dignity. More formal arrangements are needed to consult with residents about their religious, cultural and social needs so that they can be met as part of the care planning process. This should be possible once the new care plans are fully implemented and regularly reviewed. Residents would also benefit from clearer written information about forthcoming activities in the home on their notice board, so that they are aware of them and can make arrangements to attend if they wish. They would also benefit from a visiting library service, which the manager said she is still trying to arrange for them. Individual residents’ food records need to be improved so that the manager can ensure they are getting the nutrition they need. Most of the residents said that they feel safe in the home and there is an “open” culture, in that visitors are welcome and residents are encouraged to make their views known to visiting inspectors. Formal systems to protect residents from harm and abuse need to be tightened up, however, so that staff are trained and informed about what they should do and whom they should contact if they suspect a resident has been abused. Some further improvements are needed so that residents are better protected from risks of infection, including guidance and training for staff and regular checks to ensure suitable hand washing materials are made available to staff and residents where necessary. Improvements are needed to ensure that staff are recruited fairly and on the basis of their suitability to work in a care setting, are provided with formal induction training when they commence work and ongoing training so that residents can be assured of their skills and competence and have confidence that they are in safe hands. Improvements are needed to ensure that the home is well managed for the benefit of the residents living there, including formal reviews of the quality of the care provided to them, improvements in the arrangements for supervising care staff and to make the home safer for them. 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.V298384.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.V298384.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 4 Quality in this outcome is poor. Improvements are needed so that residents are consistently provided with clear information about their terms and conditions and are fully assessed so 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 home has standard contracts for new residents, 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. Not all of the residents whose cases were tracked during the inspection were aware of their contracts and copies of written contracts were missing for some of them, so these residents lacked clear information, which was apparent during interviews with them. The home’s manager said that all residents are now assessed prior to their admission to the home and she ensures that assessment information is sent to
Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 11 her on behalf of those referred by health or social services departments so that she and they can be assured the home will be able to meet their needs. Assessment information relating to residents case tracked was variable and lacked detail for some, so staff did not have full and clear information about their health and/or social care needs, including needs relating to their diverse backgrounds such as their religion, cultural background, personal relationships and disabilities. Not all of the residents interviewed in the course of the inspection indicated awareness of the assessment process for their admission to the home or that they had made a fully informed decision about it. The manager stated that 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. Visiting relatives confirmed this. Chypons DS0000055781.V298384.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. The home has an excellent care plan format but this has not been implemented so residents care needs are not clearly set out for them or care staff working with them and they are not regularly reviewed. There are satisfactory arrangements to ensure residents have access to healthcare services, but improvements are needed to protect them from the risk of medication errors. More action is needed to ensure that residents’ rights to privacy and dignity are met. EVIDENCE: None of the residents interviewed was aware of their care plan and visiting relatives were not aware of care plan reviews. The home’s care plan format addresses residents’ personal, health and social care needs, including needs relating to their culture, religion, physical and sensory disabilities and personal relationships, but was not fully completed for any of the residents whose cases were tracked. 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.
Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 13 Residents interviewed and visiting relatives all stated that they are confident about their ability to access external NHS healthcare services when they need them and staff contacted residents’ doctors on their behalf in the course of the inspection, in response to specific needs. The home promotes good health and encourages residents to keep fit and active by employing a physiotherapist to undertake individual and group work with residents. She was present in the home at the time of the inspection and residents said that they appreciate this service. Further improvements are needed to ensure that residents are protected from medication errors. This includes updating the home’s medication policies and procedures so that they are specific and relevant to staff working in this home. The home’s manager said that she is currently working on this and the task. Some of the medication records for residents who were case tracked were incomplete, so it was not clear that they had been given the medicines prescribed for them, and handwritten changes were not counter-signed to protect staff authorising changes. Although there are good storage facilities for medicines retained on residents’ behalf, medicines were not all securely locked away in the cabinets provided. Most of the residents interviewed stated that they are satisfied with the arrangements in place to ensure their privacy and dignity. They all stated that staff treat them kindly and with respect and personal care can be provided by a staff member of the same gender if they prefer. Some, however, said that they would like to have the option to lock their bedroom doors at night, as this would make them feel safer and more secure in the home. They also said that they did not feel confident that there are facilities for them to make telephone calls in private. Residents continue to need lockable storage space in their private accommodation so that they can keep their private possessions safe. Communal bathrooms and toilets are not all lockable, with facilities for staff to over-ride locks in case of emergency and the toilet most in use, because it is situated nearest to the dining room, has a curtain instead of a door, which provides little privacy. There was no obvious progress towards compliance with the requirements to improve this situation and the manger was not aware of any plans in this respect. Chypons DS0000055781.V298384.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. Residents enjoy a good quality of life in the home although some improvements are needed to improve it further. 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. Action is being taken to improve the choice of food provided although further improvements are needed so that residents’ nutritional intake is properly monitored. EVIDENCE: The residents interviewed said that the activities provided in the home are appropriate for them in terms of what they expect and enjoy doing. The home’s manager said that staff provide organised activities in the lounge in the afternoons, but residents would benefit from improved information on forthcoming events, which were not advertised on their notice board. Formal arrangements to determine residents’ religious and cultural needs and interests are included in the care planning process, but this still needs to be implemented. The manager said that she is in the process of arranging for a visiting library service in response to a specific request by a service user during a recent inspection. The home’s manager said that are no restrictions on visitors at reasonable times. Residents interviewed confirmed that their friends and relatives are able visit with them either in their own rooms or in the communal areas of the
Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 15 home. Visiting relatives said that they are always made to feel welcome in the home and the visitors’ book is very full. Residents interviewed said that they are able to make decisions about things that are important to them such as the gender of staff working with them and whether or not to join in with activities, for example. They are able to personalise their private accommodation 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. Residents interviewed gave variable responses to questions about food ranging from “excellent” to “not always very good”. The dining tables were attractively set for lunch and residents could choose to have meals served in their own rooms if they preferred. Staff were observed offering a choice of supper to residents and supper menus were published on the home’s notice board. A quality review of the food and menu choices was in progress at the time of the inspection, with records made of residents’ preferences so that menus and choices can be improved to make meals more pleasurable for them. Catering staff have recently attended healthy eating courses so that they are better informed about nutrition. Records of food served to residents are kept, but were very disordered and not dated, so it was unclear how their nutritional intake could be monitored. Chypons DS0000055781.V298384.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. 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: Residents interviewed at the time of the inspection 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 all said they would feel confident about taking any concerns to the home’s manager. At the time of the inspection, the home’s manager was 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. Most of the residents said that they feel safe in the home although some said that they would feel safer if they were able to lock their bedroom doors.
Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 17 Chypons DS0000055781.V298384.R01.S.doc Version 5.2 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 the following standard(s): 19 & 26 Quality in this outcome area is adequate. 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 residents. There are continuous improvements being made to it to make it more attractive and safer for residents and staff. Residents interviewed said that they were satisfied with the accommodation, including their private rooms. Residents, 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.V298384.R01.S.doc Version 5.2 Page 19 It was noted that the clock in the dining room has now been replaced so that residents are informed of the correct time. The home looked clean and tidy at the time of the unannounced inspection and some residents pointed this out during interviews. Domestic staff are employed to keep it clean, so that care staff can focus on providing direct care to residents. There have been improvements to the laundry flooring but other hygiene measures need improvement and 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 anti-bacterial soap and paper towels, for example, and the waste bag in the sluice room was overflowing. Chypons DS0000055781.V298384.R01.S.doc Version 5.2 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 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): 27,28, 29 & 30 Quality in this outcome area is poor. There are sufficient staff, 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 the residents can be sure that staff are suitable to work with vulnerable adults in a care setting. EVIDENCE: Residents interviewed said that there were sufficient staff to provide them with care and this was observed at the time of the inspection. Records of staff on duty confirmed this. 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 with service users. 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 and staff confirmed this during interviews. 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.
Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 21 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.V298384.R01.S.doc Version 5.2 Page 22 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, 35, 36 & 38 Quality in this outcome area is poor. The home’s manager is in the process of completing their application to be registered with the Commission so that residents 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 residents can be assured that the home is managed in their best interests, although more needs to be done on this. Residents’ financial interests are managed so that they retain control and independence in relation to their personal finances. Improvements are needed so that residents can be confident that staff working with them are properly supervised and improvements are needed to ensure that they are protected from avoidable risks. EVIDENCE: The home’s manager said that she is in the process of completing her application to be registered with the Commission. Staff and most residents who were interviewed said that they felt that the home is well managed.
Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 23 Some progress has been made to consult with residents formally about the food provided to them, but most residents interviewed were not aware of any formal consultation process and no annual development plan for the home, based on improving outcomes for residents was available at the inspection. The registered provider has not sent regular reports about the conduct and management of the home that he is required to do so that residents can be assured that the home is being managed in their best interests, although the most recently submitted report did provide greater detail and was more informative. Residents are encouraged to maintain control of their own finances, either themselves, or with the assistance of relatives and the home does not act as agent or appointee for any of them. There are facilities for residents to store money and valuables for safekeeping in the home’s safe and full records are maintained. 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 needs to be reviewed however, so that risks are identified and suitable arrangements are made to protect residents. Individual risk assessments of residents need to be reviewed and updated as part of their care planning process, with particular regard to those who are at risk of falls and the home’s environmental risk assessment needs to address the needs of service users in the lounge who may need assistance when staff are not there, as they do not have access to call bells in that part of the home. The manager said that a resident had died recently, but the Commission was not notified of this or the circumstances of their death. This is necessary so that residents can be assured that there is external oversight of major events that affect the home. Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 2 2 X N/A 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 2 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 2 X 2 X 3 1 X 2 Chypons DS0000055781.V298384.R01.S.doc Version 5.2 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 OP2 Regulation 5(1) Requirement The registered provider must ensure that all service users are provided with written statements of the terms and conditions of their placements in the home. 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. The registered provider must ensure that medicines are administered to residents as prescribed with accurate records kept and that medicines are stored safely. 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 was set at the
DS0000055781.V298384.R01.S.doc Timescale for action 01/08/06 2. OP7 15(1) 15(2) 01/08/06 3. OP9 13(2) 01/08/06 4. OP9 13(2) 01/07/06 Chypons Version 5.2 Page 26 previous inspection in light of recent changes in the management structure of the home. 5. OP10 12(4)(a) 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 was set at the previous inspection in light of recent changes in the management structure of the home. All toilets and bathrooms must be provided with lockable doors with facilities for staff to override them in an emergency. 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. Residents must be provided with facilities to make telephone calls in private and be informed of the arrangements in place to enable them to do this. Records of food provided to individual service users must be kept accurate and up-to-date Records required by regulation
DS0000055781.V298384.R01.S.doc 01/01/07 6. OP10 12(4)(a) 01/07/06 7. OP10 12(4)(a) 01/01/07 8. OP10 12(4)(a) 01/08/06 9. OP10 16(2)(b) 01/08/06 10. OP15 17(2) 01/07/06 11.
Chypons OP18 17(2) 01/07/06
Page 27 Version 5.2 19(1) 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 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 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 was set at the previous inspection in light of management changes 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
DS0000055781.V298384.R01.S.doc 12. OP18 13(6) 01/07/06 13. OP26 13(3) 01/07/06 14. OP26 13(3) 01/07/06 15. OP29 17(1) 17(2) 19 (1) 01/08/06 Chypons Version 5.2 Page 28 16. OP30 18(1) regulations. There must be evidence that 01/07/06 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. A further date was set at the previous inspection in light of management changes in the home. The registered provider must 01/08/06 ensure that induction records are maintained for all new staff employed to work in the home. The registered manager must 01/07/06 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 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. A further date was set at the previous inspection in light of management changes in the home. 01/07/06 17. OP30 17(2) 18(1)(c) 8(1) 18. OP31 19. OP33 24 Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 29 20. OP33 26 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 March 2006. 01/07/06 21. OP36 18(2) Care staff must be provided with 01/07/06 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 was set at the previous inspection in light of management changes in the home. The registered provider must ensure that the home’s fire safety risk assessment is reviewed and updated as necessary. The registered provider must ensure that risk assessments in respect of individual service users are regularly reviewed and updated. The registered provider must ensure that the Commission is notified without delay, including in writing of the death of any service user, including the circumstances of their death. 01/08/06 22. OP38 25(4) 23. OP38 13(4) 01/08/06 24. OP38 37(1) 01/07/06 Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 30 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 OP2 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. 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 considered in assessment and care plann9ing to ensure that the home will be able to meet them. Information on forthcoming social events and activities should be clearly indicated on the service users’ notice board. 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.
DS0000055781.V298384.R01.S.doc Version 5.2 Page 31 2. OP3 3. OP3 4. OP4 5. OP7 6. 7. 8. OP9 OP12 OP12 9. 10. OP12 OP18 Chypons 11. OP18 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 toilets should have paper towels and anti-bacterial soap at all times. 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. 12. OP18 13 14. 15. 16. 17. 18. OP19 OP26 OP26 OP26 OP28 OP38 Chypons DS0000055781.V298384.R01.S.doc Version 5.2 Page 32 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
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