Inspection on 05/12/07 for Chypons

This inspection was carried out on 5th December 2007.

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

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

Other inspections for this house

Chypons 20/04/10

Chypons 28/04/09

Chypons 06/05/08

Chypons 15/06/07

Chypons 21/03/07

Chypons 31/05/06

Chypons 21/03/06

Chypons 16/06/05

Chypons 09/11/04

Chypons 13/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Chypons Clifton Hill Newlyn Penzance Cornwall TR18 5BU Lead Inspector Ian Wright (accompanied by Lynda Kirkland) Unannounced Inspection 5th December 2007 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.V347170.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.V347170.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 persons(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Geoffrey Walden Knights Miss Donna Louise Norton 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.V347170.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to people who use the service of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) maximum 27 places Dementia aged 65 years and over on admission (Code DE(E)) maximum 3 places Mental disorder, excluding learning disability or dementia, aged 65 years and over (Code MD(E)) maximum 3 places The maximum number of people who use the service who can be accommodated is 27. 15th June 2007 2. Date of last inspection Brief Description of the Service: Chypons provides accommodation and personal care for up to 27 older people, three of who may have dementia and a further three who may have a mental illness upon admission. The home is situated in the village of Newlyn, near to Penzance and is easily accessible by road. All the amenities of the village and town of Penzance are close by, although there is quite a steep hill leading up to the home. There is ample car parking space for visitors in the homes grounds. The home consists of two inter-linked wings. Most of the bedrooms are for single occupancy and have en suite bathrooms. The main lounge and several of the bedrooms have spectacular sea views. There is a large lounge/ dining room and hairdressing/beauty salon. There is a small, paved terrace area on the upper floor to enable people who use the service to sit outside if they wish. The home has a lift to enable people who use the service to access the upper floor. The entrance to the building has suitable access for people with disabilities. The home has equipment and grab rails at strategic points to assist people with physical disabilities. The home is privately owned and the registered provider employs a manager to Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 5 assist him to run the home. A team of care staff, including senior carers and ancillary staff provide care and support to people who use the service. At the time of the inspection fees range from £365-£550 per week. Additional charges are made for hairdressing, newspapers and personal items. A copy of this inspection report is available via the home’s management or the CSCI website. Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over seven and a half hours in one day. Two inspectors visited the home. All of the key standards were inspected. The methodology used for this inspection was: • To case track three people who use the service. This included interviewing the people who use the service about their experiences and inspecting their records. • Interviewing care staff about their experiences working in the home. • Informal discussion with staff and other people who use the service. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. • Review the CSCI Annual Quality Assurance Assessment (annual quality assurance and data set return), which was recently sent to the commission by the provider. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better: Despite some improvement this inspection has still resulted in twelve statutory requirements. Action regarding these is required by law, and within the timescales set. This service is subject to the CSCI regional improvement Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 7 strategy. This means that if improvement does not occur in the relevant areas, within the timescales set, enforcement action will now occur. In brief requirements have been made regarding: • Improving care planning • Improving the medication system. • Improving support and training for people with visual impairment • Ensuring staff have adult protection training • Ensuring there is a satisfactory hot water supply, and also the risk of scalding is minimised. • Where necessary carpets are cleaned or replaced. • Staff receiving appropriate pre employment checks • Staff receive appropriate training required by law. • There is an improved quality assurance system, and that regulatory requirements are adhered to more effectively. • Health and safety precautions are improved. The registered persons must now take appropriate action to address these issues as detailed in the report. Failure to do so could result in legal action being taken. The commission has requested information how the registered persons will resolve these matters. The commission will take appropriate action if the registered persons fail to take appropriate action within the timescales set. 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.V347170.R01.S.doc Version 5.2 Page 8 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.V347170.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable information is provided to people who use the service and their families regarding rights, responsibilities and the service they should expect. Assessment procedures are satisfactory, for example, the registered persons ascertain people’s needs can be met before a service is offered to them. EVIDENCE: The registered persons have an assessment policy and this is satisfactory. Copies of pre admission assessments were contained on the files of people living in the home. The inspector suggested there should be more space on the form to write information, although information gathered was to a satisfactory standard. Pre admission assessments should document who was involved in the assessment and be dated. Copies of social services / health assessments are obtained where possible. All people who use the service have been issued with a statement of terms and conditions of residency / contract. Copies of this documentation are available Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 10 on the files of people who use the service. The service does not provide intermediate care. Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are generally met to a satisfactory standard, although improvement is required to care planning, guidance and training regarding people with specific disabilities, and the management of medication. This will ensure people using the service can be confident their health and personal care needs are fully met. EVIDENCE: Care plans for some people who use the service were inspected. Although adequate, and contain suitable information to assist staff to provide care, some improvements to the system are required. Most care plans have a photograph attached to them, although this is missing from some people’s files. A photograph helps staff or agency staff, who for example are new to the service, to be able to identify the individual if they have limited communication skills (e.g. so staff administer medication to the right person). Care plans include a satisfactory risk assessment e.g. regarding manual handling. Care plans should also be signed by the person who has written or updated it. Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 12 Although some people who use the service did not appear to be aware of their care plans, most people who the inspectors spoke to said they received appropriate care and support according to their wishes and needs. Care plans however need to address the personal and social care needs of people with dementia and also people who have visual impairments. Outside advice and assistance from other agencies who specialise in these needs should be sought to assist staff where this is appropriate. The staff team are currently completing life story books –which describe individual lives. This is particularly helpful to help staff to get to know people living in the home, and can be of therapeutic benefit for people living in the home. The registered manager is also introducing a key worker system. This will enable people who use the service to have a dedicated worker to monitor care, and help to meet individual needs with greater co-ordination. The registered manager said care plans are reviewed every six months. The inspectors said review should occur more frequently- for example on a monthly basis-as outlined in the national minimum standards. Health care support appears to be satisfactory. People who use the service said they had access to relevant external professionals when necessary. The inspector was impressed that a concern regarding one person’s health was dealt with very promptly. A private physiotherapist and chiropodist visit the home on a regular basis. These services are included in the fee, which is an excellent attribute of the service. The inspector spoke to the physiotherapist, who was visiting at the home at the time of the inspection. She was positive about care provided, and said people who use the service had only expressed positive comments regarding their care. The medication system was inspected. Medication is stored in cupboards and a locked trolley in a locked medication room. Medication is administered via a monitored dosage system. Some improvements to the operation of the system are required: • Better infection control procedures need to be in place e.g. the rusty tray used should be disposed of. Medication pots should be air dried or dried with paper towels rather than with a cloth towel. • The medication trolley should be chained to the wall. The medication cabinet should be affixed to the wall. • A dosage of medication for one person was signed for but did not appear to be administered. Better systems need to be in place to avoid this occurring. • If medication is not administered, the reason should be recorded on the rear of the medication sheet and preferably also in the care notes. Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 13 • • • • Medication should not be ‘secondary dispensed,’ e.g. via a dossett. It should only be dispensed via original packaging or the monitored dosage system. There should be a photograph of each person receiving medication e.g. adjacent to the medication sheet. This will help to avoid people receiving the wrong medication. Staff should sign the medication sheet when medication is received. Any authorised changes to dosages by a medical practitioner should be signed by two members of staff on the medication sheet. Dates and reasons for any changes should be documented in health care notes. Totals of tablets / other medication in stock should be recorded, and carried forward on medication sheets. This will enable an appropriate audit trail to occur. The Royal Pharmaceutical Society guidelines should be referred to regarding the management of medication. The up to date guidance can be found via the attached web link: http:/www.rpsgb.org/pdfs/handlingmedsocialcare.pdf Although some staff have received some training regarding the management of medication- training needs to be comprehensive and should include instruction by a pharmacist. Currently staff only appear to receive video based training. CSCI guidelines are available on our website. The attached web link will take the registered persons to the policy: http:/www.csci.org.uk/professional/default.aspx?page=7328&key= People who use the service generally spoke positively regarding the attitude of staff, and said staff respected their privacy and dignity. People who use the service said staff generally knock on their doors, and post is always received unopened. However the inspector observed staff entering the bedroom of one lady who has a visual impairment, without knocking or introducing they were there. A relative stated the person’s telephone is often unplugged by staff. As well as being disrespectful, this type of behaviour can obviously be distressing for somebody who cannot see. Although staff and management acknowledged better guidance and training was required for staff working with people who have various levels of visual impairment, a requirement is also issued in regard to this matter. Management said they would make contact with relevant organisations such as the Cornwall Blind Association and the Royal National Society for the Blind as a priority. Chypons DS0000055781.V347170.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. Appropriate arrangements are in place so people who use the service can enjoy a lifestyle that meets their needs. Food provided is to a good standard so people enjoy good quality meals that meet nutritional needs. EVIDENCE: There is a relaxed atmosphere in the home. It appeared to the inspectors that people who use the service could get up when they wish. Staff support was observed as being professional, relaxed and unhurried. Some organised activities are offered. For example there is a list on the notice board in the lounge which stated that planned activities for the month included a visit from the Newlyn Male Voice Choir, carols from the Penzance Brownies, and a visit from another choir. Regular bingo and gentle exercise sessions also occur. The majority of people who use the service said they had enough activities, although some people said they would like more to do. People who use the service all said they can choose whether or not to participate in activities and were aware of the options of what was available. There is a need to look at further opportunities for people with visual impairments and also people with dementia. Opportunities for recreational and social activities for these people should be addressed in individual care plans. People who use the Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 15 service said they could receive a daily newspaper if they wished. There are suitable opportunities for people to receive visitors when they wished either in the lounge or in their bedrooms. There are fantastic views from most rooms in the home which people said they very much enjoy. At the last key inspection arrangements regarding the finances of people who use the service were inspected as satisfactory. The assessment showed that management look after some small amounts of money on behalf of people who use the service. Staff did not act as appointee for government financial benefits, for any of the people who use the service. Records are kept of fees paid to the registered persons. There are facilities for valuables to be looked after on behalf of people who use the service. Records of cash looked after on behalf of people who use the service were satisfactory at the time of the last inspection. At the last inspection people who use the service said they felt their personal belongings were safe, and said nothing that belonged to them had disappeared. At the last inspection the registered persons said they provide each person who uses the service with a safety deposit box in his or her bedroom. People who use the service did not raise any concerns regarding these matters at this inspection. A minority of people who use the service have a lock on their bedroom doors. At the last inspection, management said all new people admitted to the service would be offered this facility. Existing people who use the service have been asked if they want a lock on the door. Where people have said no, or this is not appropriate due to people’s mental health needs, this has been recorded in their files. Although on this occasion the inspectors did not share a meal with people who use the service, food served was of good quality. The meal appeared to be very much a social occasion. People who use the service all said they were content with the food provided. They said there was always enough food and meals were well cooked. Chypons DS0000055781.V347170.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. Suitable complaints and adult protection procedures are in place. However the registered persons must complete Protection of Vulnerable Adults checks on new staff before they commence employment. This measure will help to give people who use the service more assurance that they are protected by people who are not fit to work with the vulnerable. EVIDENCE: Procedures regarding complaints and adult protection appear to be satisfactory. The registered persons or Commission for Social Care Inspection have not received any complaints regarding this service. The registered persons confirmed there had been no allegations of abuse, and they had not had to refer any ex members of staff for inclusion on to the Protection of Vulnerable Adults Register. Staff said to the inspectors they would discuss any concerns, complaints and allegations with the management. People who use the service said they would generally approach their relatives. Some unfortunately said they would not feel confident approaching staff regarding complaints. The registered manager said people who use the service had received a copy of the complaints procedure and said they tried to be approachable if people had any complaints. Further work should be completed to encourage people who use the service to feel confident to approach management if they have any concerns, complaints or allegations. Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 17 Some staff have received training regarding the awareness and prevention of abuse. This training needs to be delivered to all staff who work in the home. The registered persons said they would ensure this. Free training can be received from Cornwall County Council. Information regarding this can be found at: http:/www.cornwall.gov.uk/index.cfm?articleid=37718 Only one member of staff has been employed since the last inspection. This person did not receive a ‘POVA First’ check (required by law before they started employment), and the process of the person or a full Criminal Records Bureau check did not appear to have commenced. This is despite a previous immediate requirement issued at the key inspection in June 2007. If such a situation occurs again the commission will issue the registered persons with an enforcement notice. Matters regarding recruitment procedures are discussed further in the staffing section of the report. Chypons DS0000055781.V347170.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26 Quality in this outcome area is generally good, although some improvements are required to the water supply and toilet / bathroom facilities. Some carpets also need cleaning. This judgement has been made using available evidence including a visit to this service. Suitable accommodation ensures people living at the home so they can enjoy a comfortable homelife. EVIDENCE: The building was inspected. On the main floor there is a large through lounge and dining room. This has spectacular sea views of Mounts Bay from the town of Penzance to Newlyn Harbour. There is a small outside seating area where people can enjoy the view. Toilet and bathroom facilities are generally suitable. Assisted bath facilities are available for people with mobility problems. Since the last key inspection additional storage space has been developed on the first floor which is a good improvement. The majority of the communal bathrooms and toilets now have a lockable door. However these still need to be fitted to the toilet opposite rooms 10/11 and opposite ‘Unit one’. Locks on bathroom / toilet doors ensure people Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 19 who use the service have privacy when they are bathing or going to the toilet. As the registered provider has assured the inspectors this matter will be addressed in the next few weeks the previous requirement is not renotified in this report. Tiling was cracked in the bathroom next to room 21. The registered providers said they were aware of this and would address the issue shortly. There are some problems with the hot water supply in bedrooms 8 and 9. The registered provider again said he was aware of this issue, and was going to ensure hot water was supplied to these rooms via the home’s other boiler. The inspector was concerned that the water supply to the toilet next to room 19 was too hot and could easily scald residents and visitors. These matters need to be addressed. The registered persons also need to ensure the risk of scalding is minimised when people who use the service are bathing. The Environmental Health Officer can advise the registered persons regarding this matter. Decorations are generally satisfactory, although some areas, for example, in parts of the corridors some redecoration will be required shortly. There are a number of interesting pieces of sculpture around the home, and interesting paintings in a modern style. The home has two lifts. One lift links the ground floor with the lower floor, and a second lift links the ground floor to the first floor. There is also a staircase. A short chairlift allows people with mobility problems to access two of the bedrooms. All bedrooms are for single occupancy, and eighteen have an ensuite toilet. Many have lovely sea view, and all are pleasantly furnished and decorated. There are suitable laundry and kitchen facilities. People who use the service were positive regarding the facilities provided. At the last inspection the registered persons said people who use the service had been asked if they wanted a lock on their bedroom doors. Locks have been provided where requested. People subsequently admitted to the service will be offered this facility. This should be documented during the admission process. The building was generally clean and hygienic on the day of the inspection. However the inspector noted that some carpets in several of the bedrooms need cleaning. The carpets for example in rooms 14, 17, 19, and 20 need to be cleaned. As this matter was also noted in the previous key inspection report, and does not appear to have been satisfactorily addressed a statutory requirement has been issued. The registered persons said one of the people who use the service refused to have their carpet cleaned despite staff attempts to address the issue. This is accepted although continuing effort should be made where possible. Chypons DS0000055781.V347170.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory, however recruitment procedures and staff training are still poor. Subsequently people who use the service cannot be assured they will be supported by appropriately trained and recruited staff. The commission may have to take enforcement action if the registered persons do not urgent action to improve this situation. EVIDENCE: On the day of the inspection satisfactory staffing levels appeared to be provided i.e. the rota showed four care staff were on duty during in the morning, three care staff in the afternoon and two care staff in the evening. There are also two staff on waking nights. This seemed satisfactory, although it is noted that on the previous inspection, three staff were on duty in the evening. The registered persons need to monitor the situation to ensure there are satisfactory staffing levels at all times. However it is noted the home currently has a number of vacancies. In addition ancillary staff (cooks, cleaners) were on duty. People who use the service were generally positive regarding the support they received from staff- although some issues were taken back to management for further discussion as discussed elsewhere in the report. One member of staff has been employed since the last inspection in June 2007. The checks completed on this person were poor. The person is employed as a kitchen assistant, and although an application form has been completed, Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 21 no other checks on this person appear to have occurred. For example there are no references, no Protection of Vulnerable Adults ‘First’ check, and no Criminal Records Bureau check documentation on the person’s file. This was despite an immediate requirement being issued on the last inspection. The commission has stated in previous inspection reports that the registered provider has failed to complete appropriate recruitment checks. If improvement does not occur in this area, the commission will take enforcement action. Following the last inspection report, the registered provider has been subject to CSCI management review under the CSCI regional improvement strategy. This involves, for example, the provider developing an improvement plan regarding how they will bring improvement to the service. CSCI subsequently met with the registered persons to discuss the plan. We said to the registered persons if recruitment checks regarding new staff did not improve we would take enforcement action. The inspector has consulted with the CSCI Enforcement Team after this inspection, and we are subsequently requesting a letter from the registered provider to state what action will be taken to improve this situation. If we become aware of any further incidences where appropriate recruitment checks are not completed, an enforcement notice will be served to the registered persons regarding this matter. In the last report dated 15th June 2007, we were concerned that Criminal Records Bureau checks had not been completed on a number of the care staff. These checks have now been completed and are satisfactory. However, the recruitment application form still needs to have a more detailed statement by the applicant regarding their mental and physical health (as required by the regulations). There also needs to be satisfactory evidence of the person’s proof of identity. There are also in some cases not satisfactory written references for staff. It would now be difficult to obtain these references, as the staff have been employed for some time. As a minimum appropriate references must be obtained for new staff from the date of this report. Training records were also inspected for fourteen staff. By law all staff must have: • Regular fire training in accordance with the requirements of the fire authority. • There must always be at least one first aider on duty (at appointed person level). • All staff must have manual handling training. • All staff must have basic training in infection control. • If staff handle food they must receive training regarding food hygiene. • All new staff must have an induction and there should be a record of this. This matter was notified in the last inspection report in June 2007. The matter was discussed with the registered provider at a management review with CSCI on 8th August 2007. However, there has been little improvement in this area. There are significant gaps in training required by regulation. For example: Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 22 • • • • • Fire Training. Only four of the staff in the sample had attended fire training. This was in 2006, and such training needs to be completed at least annually. First Aid. Five staff in the sample had an up to date approved persons first aid certificate. Only one of the night staff over a two-night period (i.e. of four staff in total) had a first aid certificate. Manual Handling. Some training has occurred since the last inspection. Six staff in this sample had received this training. Infection control. Four staff in the sample had training in this area. Food hygiene. Three of the staff in the sample had training. The registered persons has a suitable approach to enabling staff to have the opportunity to obtain a national vocational qualification (NVQ) in care. The deadline, in the last inspection report, for appropriate action regarding this requirement is 01/01/2008. At this inspection, the registered persons said they would not be able to take appropriate action within this timescale. However despite CSCI stating to the registered provider in August 2007, that if they had difficulties complying with the timescales they should contact the commission, they did not do so. However, the registered manager did complete a training needs analysis for most staff in October 2007, stating they would receive most of the training in six months. Following the last inspection report, the registered provider has been subject to CSCI management review under the CSCI regional improvement strategy. We said to the registered persons if training was not improved we would take enforcement action. At the feedback, at the end of this inspection, the registered persons said they would arrange all of the training as a priority, and ensure it was delivered within six months. Subsequently, the inspector has consulted with the CSCI Enforcement team, and we are subsequently requesting written confirmation of the provider’s plans. We require specific dates when the training will be delivered to all the staff. If appropriate action is subsequently not taken we will serve an enforcement notice on the registered persons regarding this matter. There is evidence that some staff have received induction training. The registered manager has developed a new induction checklist which appears to be satisfactory. As no new care staff have started work at the home, this has not been used yet. Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there is some improvement, management is still not effective in ensuring the service is managed to meet regulatory requirements. This could subsequently put people who use the service at risk. EVIDENCE: The registered provider Mr G Knights lives locally and is present at the home several times a week. Ms Donna Norton has recently been registered with the commission as the manager of the home. Both seem pleasant, and keen to provide good care for the people who use the service. However, the commission does have concerns regarding repeated notifications regarding several statutory requirements, and the registered persons failure to take satisfactory action. The commission is closely monitoring this situation. Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 24 The registered persons have developed a quality assurance policy which is satisfactory. A survey of the views of people who use the service, and the views of their relatives, has been completed and this is satisfactory. Further action to ascertain people’s views could include having resident meetings, or key worker meetings. It would also be helpful if there was an annual development plan in place to state how the registered persons will continue to bring improvement over the coming year. Due to the number of repeated requirements, there still appears to be problems in the registered persons having an effective system to ensure standards are monitored, and legal requirements are being met. Subsequently the registered provider and the registered manager, together, need to develop a more effective system of ensuring standards are developed and maintained. Management of the monies of people who use the service is generally satisfactory as outlined under NMS 14. The registered persons has a satisfactory health and safety policy. There is a satisfactory fire risk assessment. Emergency call points for the fire system appear to be tested appropriately. However emergency lighting- essential if there is a fire- still does not appear to be tested appropriately, according to records. The system was last tested on 15th October, and then previously on 29/8 and 30/7. Each unit should be tested as working (e.g. switched on and off) at least monthly. Other guidance issued by the fire authority needs to be followed regarding the testing of this equipment. The fire extinguishers were serviced in May 2007. The home has a suitable fire risk assessment, which was completed in November 2007. According to records the fire system was last serviced on 18th December 2006, and the registered provider said it would be serviced again shortly. Health and safety risk assessments were completed in May 2007. Appropriate action regarding the prevention of legionella, as outlined in the last report, is still required and this requirement is renotified. Concerns regarding the risk of scalding, in some areas- due to the water being excessively hot, are outlined in the Environment section of the report. Appropriate action needs to be taken to ensure the risk of scalding is minimised-particularly when people using the service have a bath. A risk assessment, and subsequent action needs to be taken regarding this matter. The passenger lift was last serviced in November 2007. Some remedial work was required to this, and it was not clear whether this has been completed. The commission requires clarification of this, and evidence that appropriate action has occurred. Satisfactory records of testing of the assisted baths, and hoisting equipment was inspected. The registered manager said gas appliances had been serviced, and an invoice was produced dated 21st September 2007 regarding this. A copy of the gas Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 25 safety certificate however does need to be forwarded to the commission. This should always be available for inspection. Portable electrical appliances were tested in April 2007. No records were available regarding whether an electrical hardwire certificate has been obtained. This test is required every five years, must be completed, and the certificate available for inspection. The requirement regarding this matter is therefore renotified. Training in various aspects of health and safety need to take place so the registered persons meets legislative requirements (e.g. moving and handling training, fire training). This is outlined in the previous section of the report. In regard to health and safety standards and the requirements set, if the registered persons do not take suitable action within the timescales, the commission may need to take enforcement action. Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 26 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X 2 X X X 2 2 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 27 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 persons(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Timescale for action 01/04/08 2. OP9 3. OP10 OP30 Each person who uses the service should have a comprehensive care plan specific to their individual needs. Care plans need to be regularly reviewed. Reviews should be appropriately documented. Matters outlined in the body of the report need to be addressed. This will help to ensure the needs of people who use the service are comprehensively addressed. 13(2) Medication needs to be managed 01/02/08 in accordance with the Royal Pharmaceutical Society Guidelines. Matters raised in the text of the report need to be addressed. This will ensure the medication of people using the service is managed appropriately. 12, 15, 18 Improve guidance and training 01/04/08 for staff regarding the needs of people with visual impairments. For example the matters outlined in the report need to be addressed. This will ensure people with these needs receive improved care. DS0000055781.V347170.R01.S.doc Version 5.2 Chypons Page 28 4. OP18 OP30 13(6) 5. OP21 OP25 OP38 13(4), 23(2)(j) 6. OP24 OP26 13(3), 23(2)(d) 7. OP29 OP18 18. 19 All staff must receive adult protection training. This will help staff increase their awareness of abuse, and what to do if they suspect abuse is occurring There must be a satisfactory hot water supply available in bedrooms, toilets and bathrooms. Suitable precautions also must be taken to prevent the risk of scalding to vulnerable people. Matters in this section of the report need to be addressed. These measures will ensure a suitable water supply is available to people living in the home, and any health and safety risks regarding this matter are minimised. Where possible, all carpets must kept reasonably clean. This will help ensure people who use the service enjoy a pleasant and clean environment. All new staff must have a POVA First check before they start work in the home, and an enhanced CRB check before they work unsupervised. People who use the service can then be assured staff employed are not deemed by the Criminal Records Bureau as unfit to work with vulnerable people. (Immediate Requirement regarding POVA First previously issued on 16/06/07 not complied with Second Notification. ) Regarding CRB’s: Previous timescale of 01/06/2007 not complied with 9th Notification 01/06/08 01/04/08 01/02/08 05/12/07 8. OP29 19(1) Schedule 2 All staff must receive appropriate 01/01/08 employment checks e.g. two references. Other information must be received as outlined in DS0000055781.V347170.R01.S.doc Version 5.2 Page 29 Chypons the regulations (e.g. documents specified in paragraphs 1 to 9 of Schedule 2). People living in the home can then be assured appropriate information has been obtained to ascertain the fitness of staff members before they commence employment. Previous timescale of 01/08/07 not met. 4th Notification The registered person shall 01/01/08 ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. This must include suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. (For example such training must include training as required by regulation such as infection control, food hygiene, Fire training, manual handling training and first aid. [Previous timescale of 01/07/07 not met] 5th Notification The registered persons must 01/02/08 submit an action plan regarding how they will deliver training required by regulation to all staff. This needs to include: • A list of staff employed and what training by law they require. • Specific dates when staff will attend this training, so it is all completed, in the next six months • Training regarding fire, manual handling and first aid must be prioritised and should be delivered no later than in the next three months. The action plan should be DS0000055781.V347170.R01.S.doc Version 5.2 Page 30 9. OP29 18. 19 10. OP29 18. 19 Chypons 11. OP31 OP33 7, 9, 24 12. OP38 12, 13(4) 23(2)(c), 23(4)(c) received by the commission by no later than the deadline in the next column 31/03/08 The registered persons must have a suitable quality assurance system. This should ensure the service is managed effectively, and there is effective monitoring of standards and regulatory requirements. (Previous timescale of 01/09/07 not met 6th Notification) The registered persons must 31/03/08 take appropriate action to ensure any risks to the health and safety of staff and people who use the service is minimised. For example: 1. Emergency lighting must be tested at intervals recommended by the fire authority. (Immediate Requirement dated 18/6/07 not met.) 2. Ensure a risk assessment is completed regarding the prevention of legionella, and any necessary preventative measures are taken to prevent legionnaires disease. 3. A risk assessment regarding the risk of scalding must be developed. Appropriate action must occur as necessary. 4. Ensure a gas safety certificate is obtained, and a copy is forwarded to the commission. 5. Ensure the electrical hardwire circuit is tested at least every five years, and a safety certificate is obtained. A copy of this must be forwarded to the commission. DS0000055781.V347170.R01.S.doc Version 5.2 Page 31 Chypons (Previous timescale of 1st September 2007 not met. Second Notification ) 6. Carry out any essential maintenance work to the passenger lift, and provide appropriate documentation to confirm this to the commission. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered persons/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chypons DS0000055781.V347170.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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