CARE HOME ADULTS 18-65
Chapel Cottages 27 - 29 High Street Husbands Bosworth Lutterworth LE17 6LJ Lead Inspector
Chris Wroe Unannounced Inspection 5th October 2005 10:30 Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 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 Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 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 Adults 18-65. 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. Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Chapel Cottages Address 27 - 29 High Street Husbands Bosworth Lutterworth LE17 6LJ 01858 881200 01858 881200 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) Community Care Solutions Limited Care Home 13 Category(ies) of Learning disability (13), Mental disorder, registration, with number excluding learning disability or dementia (13) of places Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20 July 2005 Brief Description of the Service: Chapel Cottage is registered to provide care and support for up to thirteen people who have learning difficulties or who experience mental ill health. The home is on the main street in Husbands Bosworth, close to local shops, churches and pubs. There are bus routes nearby to Leicester and Market Harborough. Chapel Cottage has seven single bedrooms and three double bedrooms. There are two lounges – residents can smoke in one of them. There is also a dining room and kitchen. At the back of the house there is a small patio and garden area, which residents can use. Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced – staff did not know the inspector was coming. The inspection was on 5th October 2005, starting at 10.30am and lasting for four hours. Five residents talked to the inspector during the inspection, and things they said are included in the report. Some of the things residents said were: ‘The food is beautiful’. ‘The staff are very good.’ ‘I’ve lived here for seventeen years. I like it here’. The main way the inspection was done was using ‘case tracking’. This means choosing three residents who live in the home and looking at the care they get. This is done by checking records, talking to residents and to care staff, looking round the home and watching how staff look after residents. At the last inspection, most of the key standards were checked. At this inspection, the inspector checked the remaining key standards, and followed up requirements and recommendations made at the last inspection. What the service does well:
This is based only on things that were checked during this inspection. Different kinds of food that residents like are given for meals. Residents have some choices for meals, and they can say the things they want or don’t want. Residents can make snacks or drinks for themselves. Medication records are well kept and residents feel that staff give their medication properly. Some residents know when they should have medication and come to tell staff. Resident feel they can talk to staff if they have a problem. There is a complaints procedure if someone wants to complain. Staff know about how important it is to make sure residents are safe. Staff get on well with residents and know what residents like and don’t like. Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 6 Residents can say what they think about the home at residents meetings and can give their ideas. Staff know about how they need to work safely when cleaning and cooking. What has improved since the last inspection? What they could do better:
Since there are a number of agency staff working at the home at the moment, it might be better if staff made sure all details about health checks for residents were recorded in their care files so all staff could easily find any information required. Recording of disposal of medication needs to be done, to make sure medication, which is not used, is safely taken away from the home. Staffing levels are still basic, with agency staff used quite a bit. It might be better if more staff are on duty, or if a separate cook and cleaner are employed, so that care staff can spend time caring for and supporting residents. The owners must make sure staffing levels meet the needs of residents and that staff are able to spend time caring for residents. Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 7 Members of staff, who are cooking and preparing meals, have not had recent food hygiene training. Training must be provided. Staff induction training books have exercises for staff to work through, but extra time is not given to staff to do this. It might be better to give staff extra time to train and learn, given how many tasks they are already asked to do during their shift. At the last inspection, there was an issue about how staff manage the behaviour of residents, where this affects other residents. This is still an issue and staff are still feeling like they do not know how to handle these situations. The new owners plan to offer training for staff to help them manage behaviour like this, so that all residents can be treated fairly. It is strongly recommended that this is carried out without delay. It would be better if cooked stored food is labelled to show what it is and when it should be used by. Fire alarm tests have not been carried out since August 2005. It would be better if fire alarm tests are carried out on a weekly basis to ensure safety. 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. Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards under this section were checked at the last inspection. EVIDENCE: Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards under this section were checked at the last inspection. EVIDENCE: Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Residents benefit from a healthy diet. EVIDENCE: New menus have been developed and food stocks have been increased and improved. Menus show that a range of nutritious meals is offered to residents. Residents are given some choice about what they want to eat. Residents mostly said that they like the food in the home. One resident said ‘The food is beautiful’. Another resident said that they like fruit. Residents can have fruit at mealtimes, and there is fruit put out in the home for them to eat. Residents can make snacks or drinks for themselves. Two residents said that they wanted to have different kinds of cooked breakfasts more often. At the moment residents can have cooked breakfast on a Saturday. The responsible person said that this would be offered more. Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Residents are partly safeguarded by medication procedures. EVIDENCE: Medication stocks and records were mostly well kept. Residents feel that staff give their medication properly. Some residents know when they should have medication and come to tell staff. There were two minor issues about recording and giving out of medication, which were noted and changed during inspection. One member of staff who gives out medication has not had full training to help her to do this, and this should be given to all staff, who give out medication. Residents have proper health checks relating to medicines they are taking and health conditions, but information about checks was not always fully recorded. Since there are a number of agency staff working at the home at the moment, it might be better if staff made sure all details about health checks for residents were recorded in their care files so all staff could easily find any information required. Residents said that staff gave them their medicine when they needed it. New ways of working are being brought in by the new owners, but some recording is not happening during the period of change – such as recording of disposal of medication. This needs to be done to make sure medication, which is not used, is safely taken away from the home.
Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 13 Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Residents have the right to be safe and protected in the home. EVIDENCE: Residents said they felt able to talk to the manager or the staff if they have a problem. The new owners have a new complaints procedure for the home. Staff were aware of the need to protect residents from harm. They knew what to do if there was any suspicion or report of abuse. The new owners plan to provide training for staff in the protection of vulnerable adults. Residents said they felt safe in the home. Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards under this section were checked at the last inspection. EVIDENCE: The new owners are doing a full review of rooms, furniture and fittings in the home, and have committed to make improvements. These standards were therefore not checked at this inspection, but will be looked at again in future. Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 Residents’ welfare is not wholly safeguarded by staffing numbers and levels of training. EVIDENCE: Staffing levels were looked at, because this was an issue of concern at the last inspection. The home still has very basic staffing levels, with a low number of permanent staff. Two members of care staff are on duty during day time hours (7am to 9pm), and one waking member of staff at night. Staff also have to cook and prepare all meals and do cleaning in all parts of the home. The responsible person said care staff will continue cooking and cleaning because the aim is to encourage residents to develop cooking and cleaning skills in their own home and for care staff to help them. This is a good aim, but the responsible person said it will take time to introduce, and in any event, staff will need to support residents in helping them to learn daily living skills. It might be better if more staff are on duty, or if a cook and cleaner are employed so that care staff can spend time caring for and supporting residents. Agency staff are used a lot at the moment, which is not best for residents, but regular people do come in to help, who know the residents. The new owners are working to get some new staff. The responsible person said that the owners want to let all residents have a review by social services to see what their level of needs are, and to increase staffing as needed. The owners must
Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 17 make sure staffing levels meet the needs of residents and that staff are able to spend time caring for residents. Staff have received induction training books and staff handbooks from the new owners. Staff have had training in different areas to help them to do their job well. There are some gaps in training. Members of staff who are cooking and preparing meals have not had recent food hygiene training. Training must be provided. The owners will be giving staff training over the next months. The staff induction training books have exercises for staff to work through, but extra time is not given to staff to do this. It might be better to give staff extra time to train and learn, given how many tasks they are already asked to do during their shift. At the last inspection, there was an issue about how staff manage the behaviour of residents, where this affects other residents. This is still an issue and staff are still feeling like they do not know how to handle these situations. The new owners plan to offer training for staff to help them manage behaviour like this, so that all residents can be treated fairly. It is strongly recommended that this is carried out without delay. Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 Residents are able to say what they think about the home. Residents’ health and safety is mostly protected. EVIDENCE: Residents said that they felt able to give their views about the running of the home, and that they got involved in residents meetings in the home. The new owners plan to do questionnaires to get residents views about the home, and other quality assurance checks. Since the new owners have only recently taken over the home, this will be checked at the next inspection. Residents were able to talk freely with the inspector, and had been involved with other inspections. Staff were aware of how to work safely, for example locking away cleaning chemicals and wearing protective clothing. Cooked food was found to be stored in the fridge without any labelling, and fresh chilled opened produce was not labelled to show when it should be used by. Most fire safety checks are carried out regularly, but weekly fire alarm tests have not been carried out since August 2005.
Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 19 Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Chapel Cottages Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000064674.V254402.R01.S.doc Version 5.0 Page 21 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 YA20 Regulation 13 Timescale for action Records of disposal of medication 30/10/05 must be kept, to ensure that medication, which is not used, is safely taken away from the home. The owners must make sure 30/11/05 staffing levels meet the needs of residents and that staff are able to spend time caring for residents. Training in food hygiene must be 30/11/05 provided for members of staff, who are cooking and preparing meals. Requirement 2 YA33 18 3 YA35 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA20 YA33 Good Practice Recommendations It is recommended that staff make sure all details about health checks for residents are recorded in their care files so all staff could easily find any information required. It is recommended that more staff are placed on duty, or a separate cook and cleaner are employed, so that care staff
DS0000064674.V254402.R01.S.doc Version 5.0 Page 22 Chapel Cottages 3 YA35 4 5 6 YA35 YA42 YA42 can spend time caring for and supporting residents. It is recommended that staff are given extra time to train and learn (for example completion of induction books), given how many tasks they are already asked to do during their shift. It is strongly recommended that training for staff about how to manage challenging or difficult behaviour which may affects other residents is provided without delay. It is recommended that cooked stored food is labelled to show what it is and when it should be used by. It is recommended that fire alarm tests are carried out on a weekly basis to ensure safety. Chapel Cottages DS0000064674.V254402.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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