Inspection on 10/11/05 for The Chase

This inspection was carried out on 10th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

The Chase 08/12/08

The Chase 14/12/07

The Chase 07/06/07

The Chase 04/01/07

The Chase 23/05/06

The Chase 06/05/05

The Chase 11/10/04

The Chase 27/04/04

The Chase 09/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Chase 53 Ethelbert Road Canterbury Kent CT1 3NH Lead Inspector Jenny McGookin Announced 10 & 11/11/05 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 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. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Chase Address 53 Ethelbert Road, Canterbury, Kent, CT1 3NH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01322 385033 01227 463 483 patricia.@charinghealthcare.co.uk Charing Healthcare Mrs Patricia Ann Smith Registered Care Home 31 Category(ies) of Care Home for Older People with Dementia registration, with number of places The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Admissions from 9 February 2005 to be restricted to clients over 65 years of age in the registered category DE(E) Date of last inspection 06/05/05 Brief Description of the Service: This care home has been in existance for some years but Charing Healthcare have owned it since December 2003, and there are other homes in the group. The Chase is currently registered to provide care for 31 older people, most of whom have dementia. The home is currently only admitting older people with dementia, as its aim is to eventually only provide a service to this particular group. The home consists of the original building (Old House) with a more recent extension (New Wing). There are 22 single rooms, 4 with en-suite toilets, and 5 double rooms, one of which has an en-suite toilet. In terms of access and scope for community presence, this home is about twenty minutes walk from Canterbury City Centre, with all the community resources and transport links that implies. The home has on-site parking for up to six vehicles. There is a 4-hour parking restriction on Ethelbert Road between 8am and 4pm Mondays to Fridays. The home is sited almost directly opposite the Kent and Canterbury Hospital, which is on a direct bus route. At one end of the road is the junction with the Old Dover Road, which has a bus route into Canterbury, as well as the park and ride service. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which was intended to address standards not inspected at the unannounced inspection in May 2005; to review findings on some standards inspected in May, and to check progress with matters raised for attention on that occasion. This report should, therefore, be read in conjunction with the May report, in order to obtain an overview of the day-to day running of the home. The inspection process took just under fifteen and a half hours, spread over two days, and involved meetings with five residents – two, individually, and three as a group over lunch. The inspector also met with one visiting relative. Two residents’ files were selected for case tracking, and feedback forms were received from one resident and one relative / visitor. Interactions between staff and residents were observed throughout the day. The inspection also involved meetings with the registered manager, the cook and one care assistant. The inspection involved an examination of personnel records, policies and maintenance documents. Five bedrooms were inspected for compliance with the National Minimum Standards, as well as a range of communal areas. The home has two vacancies but expecting to fill these shortly. What the service does well: What has improved since the last inspection? Good progress has been made with matters raised for attention at the last inspection (May 2005) and the introduction of the new manager has had a signal positive impact on all aspects of the home’s operation inspected. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 6 Residents speak well of her and appear to be very content. The refurbishment programme is very evident and the new conservatory is a positive focal point. The manager feels the relationship between staff, residents and their families is the strongest element of this home’s operation. The atmosphere is very open and friendly. The manager feels staff morale is generally good. There are more activities and more to look forward to. What they could do better: 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 Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 8 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 standard(s) 1, 2, 3, 4, 5, 6 1. The registered person has produced an updated Statement of Purpose, but it requires further attention to obtain full compliance with the standard. 2. Each admission is secured by a statement of terms and conditions (or contract if purchasing their care privately). 3, 4. Prospective residents’ needs are assessed prior to admission. 5. Prospective residents, or their representatives, have the opportunity to visit to further inform their choice. 6. This home does not provide intermediate care. EVIDENCE: The home’s Statement of Purpose and Service Users’ Guide have both been revised to obtain further compliance with all the elements of this standard, but the Service Users’ Guide was not available for inspection by the time of issue of this draft, and an assessment of the Statement of Purpose found that it will require attention. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 9 • • • • Needs to give the relevant qualifications and experience of the registered provider Needs to detail emergency fire procedures in the care home e.g. evacuation The arrangements made for dealing with complaints needs to include timescales and needs to give CSCI as an option at any stage – not just if dissatisfied with way complaint is handled Needs to detail the sizes of rooms in the care home The Statement of Purpose is available in a font size and style likely to suit most people with a visual or reading impairment. No other languages or formats (e.g. audio tape) are reported to be currently warranted, though consideration should be given to including information on whether and how these can be made available. Given the poor recall of some residents, a checklist is also recommended to evidence their issue and receipt as part of the admission process, and to check whether other languages or formats are warranted. Feedback on the day of this inspection confirmed feedback at the previous inspection, specifically that the decision to apply to this home was influenced more by its locality (i.e. close to where the resident or relatives lived) than by any public information produced by the home itself. The admission process is a systematic one, which also necessarily takes into account any assessments from any healthcare professionals and care managers involved. And the inspector understands that each prospective placement is discussed with staff at the home to check their suitability and the home’s capacity to meet their needs. There is a trial period of up to a month before each admission is confirmed. Each placement is confirmed by a contract - one for placements, which are funded by social services or health authorities, and another for self- funders. These are generally very similar in terms of their provisions and clearly identify the allocated room number, as required. The format of the contracts is judged generally compliant with almost all the elements of this standard, and, like the Statement of Purpose, they are in a font size and style likely to suit most people with a visual or reading impairment. These could be further improved by providing more information about what is provided in the bedrooms to be occupied; and the section on the complaints procedure needs to give the CSCI as an option at any stage if that is the complainant’s preference (matter raised by the last inspection). However, feedback on the days of this inspection confirmed that from the last inspection; specifically that this process was in fact carried out on the residents’ behalf (e.g. by relatives or health/social care professionals), that they did not all recall being actively involved. All five residents were, however, content with the arrangements described. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 10 The resident, or their representative (relative, care manager etc) is invited to visit the home and there is a trial stay of a month. This home does not provide intermediate care The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11 7. The assessment and care planning processes cover a wide range of health and personal care needs, as well as some social care needs. But care plans need to demonstrate the active participation of all interested parries, most notably the residents. 8. The home is served by a range of healthcare professionals, and has adequate facilities for privacy. 9. The home has a policy and procedures for the management of medication, but one matter was subject to an Immediate Requirement Notice for attention to obtain compliance with safe practice. 10. Observed interactions between staff and residents are respectful during this inspection, and there are adequate arrangements to ensure privacy. 11. The home has a policy and procedure for managing the death of residents, which should ensure a personalised and inclusive approach. EVIDENCE: Care Planning The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 12 The format of the care plan, which follows on from the preadmission assessment is one, was designed before the emergence of the National Minimum Standards. Although it was intended to address the health and social care needs of the residents, the inspector was still finding a heavy nursing / physical care bias at the last inspection. An examination of two files on this occasions indicated a more holistic approach emerging. The format did not, moreover, used to make it clear to what extent the residents were actively being engaged in this process, or how the home established the resident’s own perspective and any unmet needs. This was found to be still the case. The manager said she does routinely consult the residents and their relatives but there can be a general reluctance to sign the care plans off, or a lack of real understanding of the process itself. Managing the behaviour and comprehension of individuals at different stages of onset dementia must be a central theme to this home’s practice, but the last inspection found that care-planning documentation needed to better reflect the practical steps required to address those individual needs. An examination of two files on this occasions indicated this was being attended to, though the inspector judged that some practice notes should be standard / universal practice anyway. At the last inspection the manager had described how she had reorganised the working arrangements, so as to dedicate a team to each of the four units in this home; and to build up the standard of daily reporting so as to better inform the monthly reviews. One senior member of staff was subsequently tasked to look at care planning formats in use in EMI homes. The manager is planning to use one-to-one sessions / appraisal meetings with staff and staff group meetings (every 4-6 weeks) to fully explore policy principles such as holistic care planning, to further increase their ownership. This is judged a very promising start. Healthcare The home has access to a range of healthcare professionals and the fact six GPs practices service this home indicates a level of person choice. There is also a complementary therapist who gives hand, head and foot massages (though this does attract a small fee). Continence advice is available from District Nurses for individuals, and one senior member of staff has been tasked to be the home’s key liaison officer on this, with the result that the inspector found much better continence management generally. The home has a generally comprehensive policy on medication, and note was taken of two matters raised for attention at the last inspection. The home uses the Boots monitored dosage system and one resident has been risk assessed able to manage her own supplements. Eight residents have diabetes, two are managed with diet, the rest have prescribed medication. The manager said The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 13 that arrangements had been made with Canterbury College for staff training. However, one matter (specifically, the drug fridge’s capacity to maintain safe temperatures) was judged sufficiently serious to warrant the issue of an Immediate Requirement Notice, and required prior and ongoing attention. Dying and Death The home has policies on the care of the dying, and terminally ill, which usefully addresses the need for a personalised approach to the level of support available from the home for residents and their relatives or friends, and this was supported by anecdotal information. Loved ones would be supported to stay with relatives. There is a section in the home’s policy on care of the dying, which usefully details a range of key elements to other beliefs (Hinduism, Judaism, Muslims, Sikhism) which would further benefit by information on local resources. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15 12. Residents are generally content with their lifestyles in this home, and the home has been able to match their expectations. This home offers a range of activities inside and outside the home, and records activities 13. There are open visiting arrangements, and the home is well placed for access to local shopping outlets as well as Canterbury City itself 14. There is some choice and control over most aspects of daily routines. 15. Some special dietary needs can be catered for. Meals are well prepared and presented, and staff are readily available to assist residents. Mealtimes are unhurried and the setting is congenial. A requirement is made in respect of the level of recording. EVIDENCE: Activities At the last inspection the inspector found that the home offered a rather limited range of activities on site. The range has been increased, with more activities in prospect. Examples include: art classes, games (Bingo, card games, one-to-one activities); “pamper days” (reflexology, hairdressing, manicures), movie days, and movement to music sessions. The inspector joined one group attending a sing-along session led by a visiting entertainer during the inspection, which was well attended and received. The entertainer The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 15 alternates with another to provide monthly visits. More activities are planned such as “Pets as Therapy” sessions The manager has introduced a key-worker system, and each key worker has been tasked to set up a Life History for each resident; to find out more about their lifestyle, social history, fears and aspirations, with positive results. For example, as a direct response to residents’ interests being identified, one or two have been given garden plots to tend. One resident’s interest in outings and concerts and another’s interests in a local church are now being actively pursued with their families. And one resident’s interest in art has been addressed by the introduction of art classes. Another resident’s onset dementia was found to have been linked to a specific vitamin deficiency and the resident is now said to be positively benefiting from supplements. Most movingly of all, one resident with dementia was reconnected with a child with special needs before his death. As reported at the last inspection a couple of residents are assisted by staff to go for walks (e.g. to a local garden centre) and some clearly enjoy the garden in good weather. A bi-monthly newsletter announces forthcoming events, though the November / December edition was still outstanding at the time of this inspection. Contact with friends, and families The home has open visiting arrangements (day and evening) and this was confirmed by one relative and residents. Three residents have private telephone lines to their rooms, and this facility is open to the others, at their own expense. Residents do, however, have ready access to a cordless handset for use in private, and the manager said there is no charge for this. This is a generous arrangement - in practice, however, it tends to be used for incoming calls only. One resident receives a call every day from a near relative. Diversity Issues The Statement of Purpose details the services available from a local Church of England, and commits the home to support residents to access the services of other religions, and there was anecdotal information to confirm compliance with this. Public information documentation would further benefit by information on how to access other cultural / religious local resources. Catering The inspector met with the home’s cook and assessed the arrangements for catering and mealtimes. Preferences are established as part of the admission and care planning process in the first instance, and confirmed on the day before thereon. There continues to be a four-week cycle and a choice of at least two options in each case. Residents can even pick and mix from the elements of each meal. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 16 Charing Healthcare does all the menu planning – the cook doesn’t have any say but does do all the food ordering, and can use a little discretion on a dayto-day basis. Dry goods and freezer goods are delivered every two weeks. A local greengrocer is used for vegetables – the cook said the home uses fresh produce mostly. The cook works from 8am to 2pm Mondays to Fridays. There is also a kitchen assistant, who works from 10am till 6pm Mondays to Fridays. There is a separate cook for weekends. The night staff are also available to prepare snacks. Neither the cook or kitchen assistant has Food Safety Hygiene certification, which was of concern, though the inspector was assured that this is being planned. See Schedule of Required Action. The meals tend to be traditional British fare though some more exotic dishes are available as second options. Eight residents are currently on a diabetic diet, and one is on a potassium-free diet. Four residents have pureed food, and the cook confirmed information supplied at the last inspection, specifically that the component elements of their meals are pureed and presented separately so that they can still experience the full range of colour, scents and textures of their meals. Several residents have their meat minced but can have their vegetables whole. In terms of equipment and assistance, the cook said there were plate guards, beakers with feeders available, but there are, perhaps surprisingly, no large handled cutlery or bendy spoons. Some residents are fed by care staff. The refurbishment programme has produced an attractive dining area. The inspector was advised that residents don’t tend to want to sit in the same place but they do like to sit with the same little groups. The cook keeps records of what people eat for lunch and supper, though the records need to be more comprehensive. Care staff are tasked to report on whether meals are eaten. The cook said she will note if individuals aren’t eating. Residents and relatives are generally satisfied with the quality, choice and presentation of meals. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 17 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 standard(s) 16, 17, 18 16. The registered manager has ensured there is a straightforward complaints procedure in place, which includes the stages and timescales for the process. Some matters have been raised for attention, and the home still needs to demonstrate a more proactive approach. 17. There are systems in place to safeguard and promote the residents’ rights, though it is judged too soon to assess their effectiveness. 18. The registered person has a range of policies designed to safeguard residents from abuse, and other measures have been introduced or are in prospect. EVIDENCE: Complaints The home’s complaints procedure is on open display and describes the process and timeframes the home is committed to, in general compliance with the provisions of Regulation 22. Some matters were raised for inclusion / amendment at the last inspection and were found to be still outstanding in respect of some versions, however. For example, some elements require updating in respect of the complainant’s right to contact the CSCI at any stage, if that is their preference, and all versions need to include the duty to notify the CSCI of serious complaints (Reg 37). Since the last inspection, the manager has introduced a new format for the registration of complaints, which is judged generally comprehensive, and benefits by a copy of the procedure at the front of the register, to ensure an The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 18 informed approach. The inspector would recommend the format of the register also includes the question as to whether to notify the CSCI. There were only two complaints in the register since the last inspection, which is not judged a realistic reflection of the home’s operation, given the number of residents and the likely diversity of needs and expectations. Currently the process relies, in practice, on the manager to log complaints. This process needs to be more universally owned by the staff team, who are best placed to pick up issues as they emerge. Advocacy As reported at the last inspection, some residents would be able to speak up for themselves, but most are unable to, in a sustained way. Since then the manager has made arrangements with CROP (Citizens’ Rights for Older People) for independent advocacy services, and this is detailed in the Statement of Purpose. One resident is reported to have accessed the service so far. Until there is more take-up, the home relies on its key worker system, families and friends to raise issues and represent the interests of the less able residents. Volunteers Where one or two residents were previously known to the community or church etc. some welcome continuity has been provided by volunteer visitors. One resident is visited very regularly by her former Home Help. The need to run checks on these long standing arrangements has not historically been indicated, but the manager is aware of the need to safeguard volunteer input in future. The home occasionally has students on work placements – who are subject to checks run by their own colleges or schools, and strict rules on what they can or cannot do. The inspector was advised that they tend, in practice, to sit and chat to residents or play cards with them and are never left unsupervised. Since the last inspection, the manager has arranged for the inclusion of contact details for a range of accredited voluntary agencies in the Statement of Purpose, but it was too early to judge the effectiveness of this. Safety and Protection All the residents who have met with the inspector over this year’s inspections have confirmed that they felt safe in this home. The home has a range of policies designed to protect the residents: adult protection, staff conduct, restraint; bullying in the workplace; covert administration of medication; and whistle-blowing (the list is not exhaustive). The home’s own policies do not, however, all refer to events to which the duty to notify the CSCI would apply (Reg 37) and should be amended to do so. The inspector would strongly recommend, moreover, that such key policies crossrefer to each other, and make reference to the relevant National Minimum Standard, to ensure a rounded approach. The Kent and Medway adult The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 19 protection protocol needs to be readily available, cross-referenced in the home’s own policies and checked for consistency with the home’s own procedures, to ensure a timely and cohesive approach. The manager is planning to introduce a checklist for staff to sign as confirmation of having read and agreed to comply with the provisions. This is judged a diligent approach. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 20 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26 19. The layout of this home is generally suitable for its stated purpose and the property is clearly benefiting from the refurbishment programme, though the décor of some areas is in need of further investment, in compliance with Regulation 7. 20. Residents have a choice of communal areas, and furnishings tend to be domestic in character. There are homely touches throughout. 21. Lavatories and washing facilities are generally accessible to bedrooms and communal areas, but these areas are in particular need of refurbishment, in compliance with Regulation 8. 22. There is a range of equipment and adaptations but periodic assessment of the premises by an Occupational Therapist are recommended to ensure the home maintains its capacity to meet the needs of the residents. 23, 24. Three bedrooms are under 10sq. metres and would not be judged suitable for use as bedrooms if this were a new registration. Most residents have access to the privacy of their own bedrooms and each bedroom is reasonably personalised. But a number of matters have been raised for The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 21 attention to obtain full compliance with the National Minimum Standards and some are in particular need of refurbishment. 25. Comfortable temperatures and ventilation are being maintained, though lighting levels in one bedroom will require further assessment / adjustment. 26. The home is in a signally better position than reported at the last inspection in terms of its continence management. EVIDENCE: General environmental issues As reported at the last inspection, the location and layout of this home are judged generally suitable for its stated purpose, and work has been carried out to tidy up the shrubs and trees, particularly on the front boundary. However, the first impression is still likely to be disappointing – the forecourt is in such a poor state of repair. The surface is uneven and fragmented and should be resurfaced as a precaution against the risk of accident and to improve the aspect. The rest of the grounds offer some interesting focal points, areas for private relaxation and access to sunlight. Three residents spoke of the pleasure they got from accessing the garden in good weather conditions. The new conservatory is well placed to offer some of the same benefits at other times. See section on Management and Administration in respect of health and safety matters. The home has a range of equipment and adaptations, but would benefit by periodic assessments by an Occupational Therapist, to ensure it maintains its capacity to meet the needs of the residents (matter raised by the last inspection). The installation of Loop systems should, for example, be given consideration for people with hearing aids. The new manager has introduced measures to significantly improve the level of odour control generally though there were still some isolated areas in need of further attention. The home only has one washing machine with a sluice cycle. This is not judged adequate. There are two sluice facilities and regular collections of clinical waste. One sluice on the 1st Floor (Area 4) was inspected on this occasion and some matters were raised for attention to obtain compliance with best infection control standards. The home’s clinical room was also inspected and a number of matters were raised for attention. Clearly, periodic inspections by Environmental Health Officers and pharmacists are to be recommended, to ensure compliance with health and safety / infection control standards. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 22 The new manager has provided a complete schedule of the home, as required by the last inspection, detailing the measurements of each room, its designated purpose and the proposed refurbishment programme, with timeframes, so that the CSCI could assess compliance with the National Minimum Standards and keep track of the refurbishment plan hereon. The schedule of required action supplied with this inspection report identifies areas of priority. Communal areas Residents have a choice of four lounge/communal areas, and lighting and furnishings tend to be domestic in character. There are homely touches throughout and the introduction of a large number of armchairs since the last inspection has significantly improved these communal facilities. Some radiators are not guarded at all in lounge areas (matter raised at the last inspection) and should, therefore be risk assessed, as a precaution against the risk of accident. The carpet in one lounge on the 1st Floor (Area 4) was stained, and will require deep cleaning or replacement. The home has its own Hairdressing Room, but it does not have ergonomic facilities such as a hairdressing sink or chair, so its use is not likely to be as comfortable as it could be. As one resident pointed out, there also needs to be an accessible mirror so that residents can observe their hairdressing in progress. Bedrooms Most residents (though this is less than 80 ) have access to the privacy of single occupancy bedrooms. Five bedrooms are shared and in four cases there are ceiling hung curtains which can be drawn to obtain privacy for each bed e.g. for medical examinations, treatment and personal care. However, left drawn, they effectively deprive the second bed of natural daylight from the window. This matter was raised at the last inspection and the manager should continue to look for opportunities to reconfigure the layout of these rooms to obtain more equitable arrangements, or consider their conversion to single occupancy, so that privacy can be obtained without compromise on other standards. The fourth double room has mobile screens and benefits by light from three windows. All the other rooms are single occupancy which means privacy can be assured. A number of matters were raised for attention in respect of furniture, soft furnishing and fitments in the five bedrooms inspected on this occasion. See Schedule of Required Action for details. The rooms inspected were reasonably personalised and radiators were guarded, though the design of the guards does allow for hands to make direct contact, which may not be in the best interests of confused residents (matter raised for attention at the last inspection). The inspector was assured that these are being replaced in stages. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 23 Most bedrooms have commodes but these tend to be very basic, obvious models, which would signal incontinence to any visitor. The inspector was advised that some commodes (along with all the commode pails) had been replaced, but only with like models. The manager should continue to look for opportunities to introduce more discreet models to accord residents more dignity. WC, washing and bathroom facilities The number and location of toilet, washing and bathing facilities is generally convenient in terms of access from bedrooms and communal areas, but there are no shower facilities (this is recommended, so that residents have a choice) and many facilities are reported to need substantial refurbishment. See Schedule of Required Action. Baths have thermostatic temperature control, but basins do not, and some taps are reported to run hotter than others. This is being checked regularly and risk assessed. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 24 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 27. There was compliance with the staffing levels as described on the day of this inspection. The waking day should, however, be extended from 12 to 14 hours, for staffing purposes. 28. The working arrangements are safeguarded by policies, staff training and recruitment processes, but a review of the status of all existing CRB checks is outstanding. 30. The home is on course to achieve compliance with the National Minimum Standard for staffing competency levels. EVIDENCE: The staffing arrangement as described at the last inspection still applies, which is largely based on the Residential Forum formula. Specifically, the manager aims to be on duty from 8.15am or 9am till 5pm most weekdays. • • • The morning shift is from 8am till 2pm; The afternoon shift is from 2pm till 8pm; and The night shift is from 8pm till 8am. One should expect to find a senior and four care staff on duty during the day time, plus kitchen staff (cook and assistant). At night there are three waking staff. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 25 There are dedicated cleanings staff from 7.30am till 3.30 or 8am till 4pm every day. The manager has recruited two more cleaning staff since the last inspection, and has discontinued using students for vacuuming duties after school. There is also a full time maintenance member of staff. With the exception of one afternoon shift, staffing rotas for the four week period (17 October to 13 November 2005) confirmed compliance with these staffing levels as described. However, this indicates a waking day of 12 hours – a 15 hour waking day is strongly recommended by the Residential Forum) so that there are sufficient numbers of staff to attend to residents in the evenings. The manager said the home was on course to achieve compliance with the National Minimum Standard for staffing competency levels and is liaising with Canterbury College over this. Six care staff are reported to already have NVQ Level 2 accreditation, two others have done the coursework but were unable to complete the process, because there were no facilities for work-based assessments. Five overseas staff are qualified nurses, waiting for adaptation training. The manager said that the home’s policies were generated by Charing Healthcare Head Office and were last updated in April 2005. The manager said she would see it as her role to ensure corporate policies were customised to meet the needs of this home and ensure their ownership by staff and residents (or their representatives). Records confirm the manager’s assertion that staff providing personal care to residents were at least 18 years of age and that staff left in charge of the home were at least 21 years of age. An audit of four personnel files, selected at random, indicated a generally systematic approach to recruitment and induction, though there were some gaps. CRB checks are managed by the Head Office, and the process includes satisfactory checks of the Vulnerable Adults and UKCC registers. T he manager confirmed that each member of staff is routinely given copies of the GSCC Code of Practice The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 26 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 31, 32. The new manager has made a good impact on the day-to-day operations of this home, and has ensured progress on a range of service improvement initiatives, with more planned. Staff and residents clearly continue to appreciate the impact of the new manager. 33. A number of Quality Assurance tools are in use or in prospect, which should maintain the residents’ interests at the centre of the home’s operations. 36. Staff are not formally supervised. EVIDENCE: Patricia Smith has been in post since 4th January 2005. Since the last inspection she has successfully undergone the CSCI formal registration process in respect of this home, having already obtained the relevant nursing and management qualifications – and expects to complete her Registered Managers Award in February 2006. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 27 The head office has assumed responsibility for leading on quality assurance tools for inspection, to ensure a corporate approach across the group of homes and to enable overall prioritisation of issues. One initiative was said to have been launched a few weeks before this inspection, but it was too soon to see the findings. There are regular Environmental Audits, which commit the organisation to practical action plans and timeframes; and ad hoc meetings with relatives (dependant of their availability) and one-to-one meetings with residents; regular bi-monthly staff group meetings (there have been two so far) to increase ownership of policies as well as to discuss operational matters). There are clear lines of accountability within the home and within Charing Healthcare, although the challenge for the organisation continues to be to demonstrate its support for this manager and its readiness to invest resources into the proposed refurbishment plan, to obtain full compliance with the National Minimum Standards. A good start has been made with improvements introduced since the last inspection. Staff report that line managers are readily available for advice and support. Less clear, however, was compliance with the National Minimum Standard for formal staff supervision sessions. The arrangements for managing residents’ finances were not inspected on this occasion, as families and other parties outside the home’s control have responsibility for this. All maintenance checks inspected were up to date and systematically maintained, but the standard of décor indicates the need to take a more robust approach. Periodic assessments by an Occupational Therapist are recommended, to ensure the home and site maintain their capacity to meet the needs of the residents. Periodic inspections by Environmental Health Officers and pharmacists are also recommended, to ensure compliance with health and safety standards. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 28 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 3 1 2 3 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 2 3 3 3 x x 1 2 2 The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 29 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 OP1 Regulation 4& Schedule 1 Requirement Statement of Purpose. This document requires further attention to obtain full compliance with this standard. Matter raised by the last inspection - original timeframe 30 06 05 The latest edition of the Service User Guide needs to be submitted to the CSCI for assessment against the standard. Care plans must demonstrate the active participation of all interested parties, most notably the resident (or their representatives). Matter raised by the last inspection - original timeframe 30 06 05 The drug fridge’s lack of capacity to maintain safe temperatures was judged sufficiently serious to warrant the issue of an Immediate Requirement Notice, and will require attention Records of meals must be sufficiently comprehensive to enable anyone authorised to inspect them to assess the quality and variety of each residents intake Timescale for action 31 03 06 2. OP1 5 31 01 06 3. OP7 15 31 03 06 4. OP9 13(2) 10 11 05 5. OP15 16(2) 31 01 06 The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 30 6. OP16 22 & Schedule 4(11) 7. OP19 23(2) 8. OP21 23(2) 9. OP24 23(2) 10. OP25 13 11. OP26 13 12. OP26 13 Complaints Procedure. This requires updating: - in respect of the complainant’s right to contact the CSCI at any stage, if that is their preference, and all versions need to include the duty to notify the CSCI of serious complaints (Reg 37). Matter raised by the last inspection - original timeframe 30 06 05 The forecourt requires attention as a precaution against the risk of accident. Action plan to be submitted WCs – 1st Floor Area 1, and 1st Floor Area 4. Both areas require attention to obtain compliance with the regulation. The following bedrooms will require attention to obtain full compliance with the National Minimum Standard and attendant regulations: - Bedroom 3 - Bedroom 4 - Bedroom 5 - Bedroom 6 - Bedroom 25 Action Plan to be submitted All unguarded radiators and radiators with wide-spaced bad guards must be risk assessed, as a precaution against the risk of accident Sluice (1st Floor - Area 4). The walls, ceiling and flooring must be attended to, to obtain suitable infection control standards Action plan to be submitted Clinical Room. The walls, ceiling and flooring must be attended to, to obtain suitable infection control standards. Action plan to be submitted. 31 01 06 31 01 06 31 03 06 31 03 06 31 03 06 31 03 06 13. 14. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 31 15. 16. 17. 18. 19. OP26 OP36 OP38 13 18 16(2)(j) Hygiene. Some areas of the home still require better continence management There needs to be formal staff supervision in place to comply with this standard All staff likely to be involved in the handling of food or the preparation of meals must be suitably trained in Food Safety standards. 31 03 05 31 03 06 31 03 06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations Contract. This document could be further improved by providing more information about what is provided in the bedrooms to be occupied; and the section on the complaints procedure needs to give the CSCI as an option at any stage if that is the complainant’s preference (matter raised by the last inspection). Public information documentation would further benefit by information on how to access other cultural / religious local resources. Complaints. - The format of the register should include the question as to whether to notify the CSCI. - The complaints process needs to be more universally owned by the staff team, who are best placed to pick up issues as they emerge. Adult Protection. - All relevant policies likely to refer to events to which the duty to notify the CSCI would apply (Reg 37) should be amended to specify so. - Such key policies cross-refer to each other, and make reference to the relevant National Minimum Standard, to ensure a rounded approach. - The manager should also secure a copy of the Kent and Medway protocol. This protocol need to be readily H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 32 2. 3. OP13 OP16 4. OP18 The Chase 5. 6. 7. 8. OP24 OP26 OP25 OP25 9. 10. OP38 OP38 available, cross-referenced in the home’s own policies and checked for consistency with the home’s own procedures, to ensure a timely and cohesive approach. The homes Hairdressing Room should have ergonomic facilities to make their use more comfortable, and there should be an accessible mirror. The registered person should assess the suitability of the homes laundry facilities. All unguarded radiators and radiators with wide-spaced bar guards should be risk assessed, as a precaution against the risk of accident The manager should continue to look for opportunities to reconfigure the layout of the double rooms to obtain more balanced lighting arrangements, or consider their conversion to single occupancy, so that privacy can be obtained without compromise on other standards. Periodic assessments by an Occupational Therapist are recommended, to ensure home and site maintain their capacity to meet the needs of the residents Periodic assessments by an Environmental Health Officer and pharmacists are strongly recommended, to ensure the home maintains satisfactory levels of hygiene / infection control. 11. The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 33 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Chase H56-H05 S57129 The Chase V248315 101105 Stage 4.doc Version 1.40 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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