Inspection on 23/05/06 for The Chase

This inspection was carried out on 23rd May 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 10/11/05

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 June Davies Unannounced Inspection 23rd May 2006 09:30 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 The Chase DS0000057129.V291839.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. The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Chase Address 53 Ethelbert Road Canterbury Kent CT1 3NH 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) 01227 453483 01227 463483 Charing Healthcare Vacant Care Home 31 Category(ies) of Dementia - over 65 years of age (31) registration, with number of places The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Admissions from 9 February 2004 to be restricted to clients over 65 years of age in the registered category DE (E). 10th November 2005 Date of last inspection 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 home fees range from £447-£484. The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key visit took place over 14 hours by two inspectors, Mrs June Davies and Mrs Chris Randall. An immediate requirement letter was sent to the provider following day one of the key inspection. The inspectors spoke to four residents, two visitors to the home, four staff, and one visitor who was entertaining the service users. Documentation relating to the home was also seen, and a tour was made of the interior and exterior. Observations were also made by the two inspectors. What the service does well: What has improved since the last inspection? What they could do better: Over the past two and half years the home has not been managed in a way that ensures people living there are safe and well cared for. The acting manager has only been in post for the past month, but must ensure that she obtains suitable qualifications to ensure that she can apply for registration. The following serious concerns must be dealt with immediately. These concerns were that the back secure garden is a risk hazard to any service user, and the front parking area must also receive immediate attention to the surface and blocked drains. The standard of hygiene throughout the home must improved to eliminate unpleasant odours, and badly stained carpets throughout the building must be replaced, to prevent the risk of cross infection. Cleaning standards throughout the home and the laundry must be improved to again prevent the risk of cross infection and communicable diseases. The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 6 Care plans must be made available to all service users and/or their relatives/representatives. Appropriate pre-admissions and risk assessments must be carried out for each individual service user, to ensure their needs can be met. Personal hygiene care must be recorded, evidence and daily reporting produced within the care plan of professional visits. Care plans must be reviewed at least once a month with service users, relatives/representatives being involved. Medication must be administered in accordance with pharmaceutical guidelines. Many of the residents comments regarding food was negative, and the quality of food produced must be improved upon. The home must provide sufficient experienced staff on duty at all times. All staff must be recruited properly with appropriate documentation in their personnel file, have a proper induction in line with Skills for Care, be appropriately trained to meet the assessed needs of the service users, and must have formal supervision at least six times per year. The premises must have a planned maintenance and renewal programme to ensure service users live in a homely environment free from risk. Quality assurance systems must be developed to ensure the home is providing a quality service to the service users. 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 DS0000057129.V291839.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Chase DS0000057129.V291839.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 3 and 4 The quality in this outcome areas is poor. Service users are not provided with sufficient information on contracts/statements of terms and conditions to give them full information. Pre-admission assessments do not obtain sufficient evidence on which to base a service users care plan. There was no evidence to suggest the home could meet the needs of some service users. EVIDENCE: Statement of Purpose and Service User Guide were seen, and while they have been updated from the previous inspection, there was no date to show when these documents had been reviewed/updated. Charing Healthcare does have contracts/statements of terms and conditions, there was evidence of copies being retained in the office, but it was noted that The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 9 these contracts did not state the fee being charged, and by whom the fee would be payable, none of the contracts/statements of terms and conditions were signed by the service users or their representatives. The inspectors viewed the homes pre-admission assessments, and found them to be mostly based on a tick list which therefore does not give a true picture on which to base a care plan. Two of the files looked at did contain care manager pre-admission assessments. The inspectors found that three service users had been admitted to the home out of registration category, and in the case of one service user, staff had received no training to deal with their diagnosed illness. The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Quality in this outcome area is poor. Care plans do not give sufficient evidence to ensure that all the service users needs are met. Health care is reactive rather than proactive and ongoing monitoring of health is poor. Administration of medication is generally good, but attention needs to be paid to detail to ensure the well being of the service users. Staff interaction, and explanation needs to improve to ensure the dignity of the service users. EVIDENCE: Individual care plans were available and inspectors viewed care plans of four service users. None of the care plans showed evidence of service user/representative involvement. There was lack of evidence to show crossreferencing between professional visits, health issues and daily reports. From evidence gained from accident records and service users who fell regularly, there was no evidence to show that risk assessments with regard to falls had The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 11 been updated. The four care plans viewed showed there was no regular monthly review. Daily records are completed but in some instances there were some daily gaps. In some health histories abbreviations had been used, which could lead to misunderstanding and incorrect care. Service users spoken to had no recollection of having seen their care plan. Personal hygiene e.g. bathing, hair washing or dental care was not recorded appropriately in the four care plans seen by the inspectors. Many of the service users need specialised assistance with continence care, while staff make requests from district nurses for aids, no referral had been sought from the continence care nurse by previous or the present acting manager. Only trained staff administer medication, and a list of initials of staff able to administer medication were available and up to date. The acting manager has no training for the administration of medication but was due to attend a oneday training course on the 24/05/06. The homes medication policies and procedures were up to date. MAR sheet folder contained G.P. authorisation for homely remedies. The drugs fridge has been replaced and temperatures are monitored on a daily basis. Medication received is not always recorded appropriately on to the MAR sheet with date of receiving, amount of medication and staff initials. On one service user’s MAR sheet medication was prescribed as TAKE AS DIRECTED, and inspectors require the acting manager to ensure that the G.P. prescribes with clear directions for administration. During the visit to the home, two relatives stated that staff do not always treat the service users with respect – “staff do not always explain what they are going to do” – “some staff are good, but some staff do not talk to my mother”. A requirement has been made for all staff working in the home to respect the dignity of the service users. The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15 Quality in this outcome area is adequate. Service Users who are mobile around the home are offered a variety of activities throughout the week. The standard of meals in the home need to improve together with staffing levels, to meet the needs of all service users EVIDENCE: The home has an activities programme, and on the day of the visit the inspectors witnessed an organist entertaining the service users, with many of the staff involved in this activity. Evidence was also available in the home to show that service users enjoy painting and pottery sessions, and their work was on display in the home. It was noted during the visit, that service users wishing to remain in their bedrooms receive limited attention and communication from staff. On the day of the visit the inspectors witnessed service users enjoying their lunch, and some service users had been supplied with specialised eating aids. Service users are given a choice of food they wish to eat at each mealtime and this was verified in the record of food eaten in the home. Six service users The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 13 have soft diets and inspectors witnessed these meals to be appropriately served with each item being separately liquidised. The cook verified that she was able to cater for diabetic, potassium cholesterol diets. Comments regarding meals in the home from service users were “I like the meals”, “not nice”, “food is reasonable, sometimes good, sometimes not so good”, “the food is not always very good”, “I do not always like the food but you have to eat, don’t you”, “food is some and some.” Comments from relatives were – “not brilliant at present – varies”, “she has to be fed, staff don’t always make sure she drinks her drinks”, not all meals are good, they are not very appealing, some residents say to me that they do not like to complain.” Inspectors observed two service users sitting in a side lounge one service user was served with their meal while another service user was not presented with a meal while the inspector was present, one service user was seen sitting in their bedroom at 17.10 with their uneaten sweet from lunch still in front of them. The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in the outcome area is adequate. The home has a good complaints policy and procedure, which service users staff and visitors are aware of. Staff are aware of POVA, but some policies and procedures need to be updated to ensure the protection of the service users. EVIDENCE: The home has a recently reviewed complaints policy and procedure, but again this was not dated on review. There have been no complaints in the home since the acting manager took up her position. One complaint since last inspection was properly recorded investigated and remedied. The home has a complaints book but this is locked in the acting managers office, the inspectors recommend that the complaints book is available at all times in the home. Staff spoken to during the visit, stated that they would know how to pass on a complaints. One relative said they she would know how to make a complaint. Three service users when asked about knowing how to make a complaint stated – “No”, “I never say if I don’t like”, “Yes I would tell whoever is available. One relative said they would go to the manager if they have a complaint. Staff stated that they understood POVA; they felt confident in recognising abuse if it occurred. All staff interviewed were aware of whistle blowing policy and procedure, and the home’s policy on POVA. The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 15 The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25, 26 Quality in this outcome area is poor. Both internally and externally the home is not well maintained, and therefore places the service users at risk. EVIDENCE: Inspectors noted odours in the home as soon as they walked through the front door on these key visits. Many of the carpets throughout the home were dirty and unwholesome, this included hallways, and service users bedrooms. A relative also mentioned the odour in the home. Requirements made at a previous inspection have not been met e.g. repairs to forecourt, repairs in communal toilets, unguarded radiators still unguarded, walls ceiling and floor in sluice room has still not been attended to. On inspection the back garden while being secure, was not safe for the service users to use. The inspectors found raised tree roots, lumps of concrete, sawn off tree trunks in the lawn area, a patio area that was raised at least 10 inches The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 17 above ground area, with no safety rails, paving slabs were uneven, one ramp from rear of building was in a poor state of repair, earth pathway round back of shed had breezeblocks, bricks and rocks, which were hazardous. A security light had been fixed at a very low level on the summerhouse and could cause an injury to service users should they walk into it. The area just outside the kitchen was littered with cardboard boxes, unused furniture and rubbish. This area was also being used as a smoking area by staff under an open kitchen window. A pathway in this garden was covered in moss and would be a slip hazard to any service user using it. The front parking area was very uneven with eroded concrete areas around drainage. The drains in the car park were blocked with debris, and the whole surface was very uneven. Fencing to the secure side garden needs attention. There is not sufficient dining room space in the home to cater for all the service users, and a requirement was made regarding sufficient space being provided for all the service users in the home. Many of the bedrooms were in a poor decorative order, only one bedroom viewed was nicely decorated and looked homely and reflected the personality of the service user using that room. Many of the bedrooms were impersonalised. Inspectors observed boxes of incontinence aids in full view of anybody entering those service users bedrooms. En suites in bedrooms did not have call bells in situ. Laundry room needs tidying and requires liquid soap and paper hand towels. The home has an industrial washing machine with appropriate disinfecting and sluicing facilities, but programmes are not being used on the correct programme to appropriately disinfect towels and bedding. Pipe work, shelves and architrave were all dusty. very poor throughout the home. Cleaning in general was Requirements made at a previous inspection in regard to toilets had not been met and will be repeated in this report. Ground floor bathroom had very poor lighting, was very institutionalised, the bath had chipped enamel, and a wire crate was propping the bath up. The home does not have sufficient bathrooms, and one bathroom situated behind the laundry room is inaccessible. The home has not had an occupational health assessment in regard to adaptations and equipment, The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. Lack of staffing levels, qualifications, recruitment practices, mandatory training and induction in the home leave the service users at risk. EVIDENCE: Staffing levels are poor because newly appointed staff that should be working on one to one supervision, were included onto the working staff rota. On the day of the visit one carer had just started employment that day and had no previous experience, the acting manager stated that she should be working supervised, but the Inspector noted that this carer was written into the night staff rota for the following week. This new member of staff had no mandatory training, which will leave service users and the member of staff at risk. On a second visit to the home another new carer was observed as working with a senior carer, and the new staff rota reflected this. Staffing levels were down on the afternoon of the visit because one member of staff had telephoned in sick. Visiting relatives stated that staffing levels were variable. Staff commented that sometimes staffing levels were sufficient, but were low at present because new staff needed to be recruited, and staffing levels could also be low during annual leave and sickness. The acting manager stated that she was trying to recruit, new members of care staff. On checking the training matrix, inspectors found that only 37 of care staff were trained to NVQ level 2 or above. The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 19 The application form does not comply with revised NMS schedule 2, which requires a full employment history. Gaps in employment were not investigated. One personnel file viewed only had one reference. There were also references addressed to ‘Who it may concern’. Only two staff in the home have dementia care training, this leaves 22 staff working in a dementia care home with no service specific training. Not all staff have completed mandatory training. The inspectors were not shown any evidence of induction training to ‘Skills for Care’ standards. The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, and 38 Quality in this outcome area is poor. The management of this home is adequate overall, but with lack of quality assurance, and health and safety issues in the home, this could place service users at risk. EVIDENCE: The acting manager while having a HNC business finance management qualification does not have experience of managing in a residential care setting in recent years. Four service users spoken to by the inspectors said ‘the new manager was very nice, but they did wonder how long she would stay’; one service user said that the new manager ‘has no experience’. The acting manager has no medication training but is due to undertake one day’s medication training on the 24/05/06. Four members of staff said that the new acting manager offers support, but staff did say they did not feel supported by The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 21 senior management. A visitor to the home said that in her opinion the management in the home has improved. The acting manager has very little knowledge of records kept in the office, and is unable to lay her hands on all documentation, and she did admit to not knowing where everything is at the present time. From observations during the inspectors visits to the home the acting manager is always available to staff and visitors when on duty. While the company do send out questionnaires to the services users at intervals during the year, there are no quality assurance surveys sent to visiting professionals, staff and relatives. The acting manager is in the process of carrying out internal risk assessments, but these have not been completed to date. At the present time there is no such risk assessment for external areas of the home. No synopsis of quality assurance has been developed. Through discussion with staff it became evident that none of the staff in the home receive formal staff supervision, and what supervisions has taken place in the past has been very vague and only lasted a few minutes. There was very little evidence that the management in the home supports safe working practices, and this became evident when inspector viewed training matrixes and talked to staff on duty. Evidence showed that many staff had not completed moving and handling, fire safety, first aid, food hygiene and infection control training. The acting manager stated that the company had made application to a gas company, for maintenance of the boilers in its homes. Due to the age of the boilers at The Chase, the gas company had declined to service these boilers. Certificates were not available to show that the boilers were regularly maintained or in good working order. The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 22 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 2 1 1 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 1 1 2 1 1 1 1 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X X 1 X 1 The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 (b)(c) Schedule 4 (8) Requirement A standard form of contract/statement of terms and conditions to include method of payment and fees, and to be signed by the Service User and or their representative. Pre-admissions assessments to be holistic and supply sufficient information on which to base a care plan The registered person is able to demonstrate the home’s capacity to meet the needs of the service users including specialist needs. Care plans must demonstrate the active participation of all interested parties, most notably the resident (or their representative) and must detail the practical steps which need to be taken by staff to address residents’ holistic needs (Outstanding requirements from previous inspection on 30/06/05) Service Users falls risk assessment to be reviewed and updated, especially where there are concerns in regard to accidents. DS0000057129.V291839.R01.S.doc Timescale for action 17/07/06 2. OP3 14 Schedule 3 18 (1)(a)(b) (c) 15 17/07/06 3. OP4 17/07/06 4. OP7 01/08/06 5. OP7 13 (4)(b) (c) 15 Schedule 3 17/07/06 The Chase Version 5.2 Page 24 6. OP7 13(1)(b) 7. OP7 15 (2) 8. OP8 12 (1)(a)(b) 9. OP8 12 (1)(a)(b) 13 (1) (b) 17 (1)(a) (3)(a) Schedule 3 (3) (i) 13 (2) 10. OP9 11. OP9 12. 13. OP10 OP15 12 (5) (b) 16 (2)(i) 14. 15. OP15 OP19 12 (1) 23(1)(a)( b) (2)(b) (4)(a) 23 (2)(d) (5) 16. OP19 Care plans must cross-reference between professional visits, health matters and the daily report. Ensure that care plans are reviewed each month, and be updated to reflect the changing needs of the service users. Care plans must reflect the assistance given by staff to personal hygiene issues, such as bathing, hair, oral care, checking tissue viability, nails etc. For the home to use the service of the continence to provide appropriate training for staff and advice to service users. All medication received into the home should be recorded onto MAR sheet with date received, amount of medication and initials of person recording this information The acting manager to discuss with G.P/Pharmacist directions re ‘Take as directed’ and ensure there are clear directions as to when this medication should be taken. For staff to maintain good communication skills with all service users. Food served to service users must always be nutritious, properly cooked and presented to high standard. There must be sufficient staff on duty at mealtimes to offer assistance as and when required. The location and layout of the premises is suitable for its stated purpose; it is accessible, safe and well maintained. IMMEDIATE REQUIREMENT. A programme of replacement of carpets throughout the building DS0000057129.V291839.R01.S.doc 17/07/06 17/07/06 17/07/06 17/07/06 17/07/06 17/07/06 17/07/06 03/07/06 03/07/06 02/06/06 17/07/06 The Chase Version 5.2 Page 25 17. 18. OP20 OP20 23 (2)(e)(g) 23(2)(e) 19. OP21 23(2)(j) 20. 21. OP22 OP24 23(2)(n) 23(2)(d) 22. 23. OP24 OP25 16(2)(c) 23(2)(e) 23(1)(a) (2)(p) 24. OP25 13 (4)(a)(c) 23 (2)(p) 13 (3) (4)(a)(c) 16(2)(k) 25. 26. OP25 OP26 should be submitted to CSCI, this should also include redecoration of bedrooms and replacement of bubbled rubber flooring in the passenger lift. Sufficient dining space must be available for all service users in the home Hairdressing room not to be used as a storage facility and to be provided with ergonomic facilities and a mirror. This was a previous recommendation Sufficient bathrooms are provided to meet the needs of the service users and comply with 1 bathroom for every 8 service users. En-suite facilities must be provided with accessible call bell/alarm facility. Recently re-decorated service user bedrooms must be completed; with attention paid to splash backs (provision of grouting) behind wash hand basins and a sealant must be placed between the wash hand basins as the wall. Furniture in service users private accommodations must be kept in good repair Lighting in service users accommodation meets the recognised standards, is domestic in character and includes table level lamp lighting. All unguarded radiators and radiators with wide-spaced guards must be risk assessed as a precaution against risk of accident. Previous requirement Hot water taps throughout the building must deliver hot water at a temperature of 43°C. The provider is required to submit an action plan within two DS0000057129.V291839.R01.S.doc 01/08/06 01/08/06 01/08/06 01/08/06 01/08/06 24/07/06 24/07/06 24/07/06 17/07/06 02/06/06 Page 26 The Chase Version 5.2 27. OP26 13(3) 28. OP26 13(3) 29. OP26 23(2)(b) 30. OP27 18(1)(a) 31. 32. OP28 OP29 18(1)(a) 19(4)(b) Schedule 2 33. OP29 19(1) weeks, detailing how satisfactory standards of incontinence odour are to be obtained and maintained thereon. The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with the relevant legislation and published professional guidance. THIS WAS AN IMMEDIATE REQUIREMENT FROM THE LAST INSPECTION AND FROM THIS KEY INSPECTION ON THE 23/06/006 Bed linen and towels should be laundered at the required temperature to prevent spread of infection All service users should have their own toiletries i.e. soap and shampoo to prevent cross infection The walls ceiling and flooring must be attended to in the sluice. This was a previous requirement from the last inspection. New staff must not be counted as part of staff rota until such time as they have completed preliminary induction, a suitable CRB has been received, and the new member has received mandatory training. The home should have a minimum of 50 of care staff trained to NVQ Level 2 or above Application for employment forms do not comply with Schedule 2 regulations. These forms should request full employment history, and request membership of professional bodies. All personnel folders should include at least two written DS0000057129.V291839.R01.S.doc 17/07/06 17/07/06 17/07/06 17/07/06 02/10/06 17/07/06 17/07/06 Page 27 The Chase Version 5.2 Schedule 2 34. OP30 12(1)(a) 18(1)(a) 18 (1)(c)(i) 9 (1)(2)(b) 35. OP30 36. OP31 37. OP33 24 (1)(a)(b) (2)(3) 38. OP30 39. OP36 40. OP38 12 (1)(a)(b) 13 (4)(c) 18 (1)(a)(c) 18 All care staff to receive formal (1)(c)(i)(2 supervision at least six times per ) year. Outstanding requirement from previous inspection. 13(3) Sufficient measures to be in 16 (2)(j) place to prevent infection and toxic conditions and the spread of infection at the care home. IMMEDIATE REQUIREMENT 23/05/06 references, one to be from previous employer. References addressed to ‘Whom it may concern’ must not be accepted. All staff employed must have received mandatory training in the first six months of their employment All care staff must receive Dementia Care training to meet the needs of the service users in the home The acting manager gains qualifications to NVQ Level 4 and RMA and is familiar with conditions/diseases associated with old age. Quality assurance systems need to be developed, using questionnaires to professionals, relatives/representatives and staff. Internal and external risk assessments should be carried out regularly to highlight areas needing attention. A copy of analysis should be forward to CSCI and provide consultation with service users and their relatives/representatives. Induction training for new staff must meet the requirements of Skills for Care standards as well as mandatory training. 17/07/06 17/07/06 02/09/06 01/08/06 17/07/06 17/07/06 02/06/06 The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 28 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. 3. Refer to Standard OP12 OP16 OP18 Good Practice Recommendations Public information documentation and staff would benefit by information regarding cultural/religious resources. The acting manager to make complaint’s forms available to senior staff so they are able to record any complaints made when the acting manager is not in the home. Recommendation made at previous inspection and not met. Policies, which would apply to Reg.37, should be amended to specify this. Key policies should cross refer to each other and refer to NMS. A copy of the KCC POVA protocols and guidelines should be secured, and readily available to staff and cross-referenced in the homes POVA policies and procedures. Double bedrooms need to be assessed to obtain better lighting or conversion to single occupancy to obtain better privacy without compromising standards. Recommendation made at previous inspection. 4. OP25 The Chase DS0000057129.V291839.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Kent and Medway Area Office 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. 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