Inspection on 04/01/07 for The Chase

This inspection was carried out on 4th January 2007.

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 23/05/06

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 Chris Randall Unannounced Inspection 4th January 2007 09:00 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.V320638.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.V320638.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 Post Vacant Care Home 31 Category(ies) of Dementia - over 65 years of age (31) registration, with number of places The Chase DS0000057129.V320638.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). 23rd May 2006 Date of last inspection Brief Description of the Service: The Chase is a 2-story building consisting of an original house with a more recent extension. It is owned by Charing Healthcare, who also own several other homes in the area. The home is registered to provide care for up to 31 older people, most of who have dementia; there is a condition on the registration restricting admission to clients over 65 years of age with Dementia. The home is located about twenty minutes walk from the busy city of Canterbury. It is almost directly opposite the Kent & Canterbury hospital and is on a direct bus link. There is on site parking for up to six vehicles and on street parking which is restricted to 4 hours between 8-4 Mondays to Fridays. The current fees for the service at the time of the visit range from £300 to £400 per week. Information on the Home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. There is no e-mail address available for the home. The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on evidence gained from a Pre-Inspection questionnaire completed by the provider; comment cards received from service users, relatives, health & social care professionals, G.P’s and care managers; and a site visit to the home by two inspectors lasting 6¾ hours. The site visit included talking with service users, visitors, visiting professionals, staff, and the acting manager and area manager; various observations; a tour of the premises and grounds; and inspection of a variety of records. What the service does well: What has improved since the last inspection? The home have worked hard to address the numerous requirements made on the last report although there is still a lot of work still to be completed. The care of the service users has improved and this was confirmed by visitors and visiting professionals. A number of carpets have been replaced, new furniture has been placed in service users bedrooms, and an additional dining area has been provided in the upstairs lounge The home is now clean and visitors are no longer greeted by an unpleasant odour, although work on this is still needed in some areas. The front car park has been block paved and the unsafe rear garden area has been fenced off to ensure safety until further works can be carried out. The home has developed its Quality Assurance. Various improvements have been made to the care plans and assessments although there are still some areas that need further improvement The amount of staff training has increased since the last inspection. The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 6 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 summary of this inspection report can be made available in other formats on request. The Chase DS0000057129.V320638.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.V320638.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, & 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users will have their needs assessed prior to admission to the home and they will be issued with a contract of terms and conditions. However, some improvements are needed to the contract to ensure clarity; and further planned improvements to assessment documentation will ensure they are more comprehensive and give a better indication that the home will be able to meet the needs of the prospective service user. EVIDENCE: Pre-admission assessments have improved but they need to be more comprehensive. A more detailed assessment form is being introduced into the home and a recommendation has been made that Pre admission assessments The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 9 should be further improved, as planned, to ensure they are holistic and supply sufficient information on which to base a care plan. This was previously a requirement but has been reduced to recommendation as work is already in progress to comply. Contracts now include the room number but fees are only shown on private contracts. It was explained that the County Council do not wish to have the fees shown on the contracts and it is suggested that a copy of the Council’s funding agreement is attached to the contract for these service users. A recommendation has been made that details of the fees payable and by whom should be attached to the service users contract. This was previously a requirement but has been reduced to recommendation to reflect work already carried out. All contracts inspected had been signed by the service user or their representative. This home does not offer the facility of intermediate care. The Chase DS0000057129.V320638.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are treated with respect and their privacy and dignity are upheld. The staff, supported by a multi-disciplinary health care team meet the health care needs of the service users. Each service user has an individual care plan but information recorded in these plans needs to be more complete. Medication policies and procedures need to be reviewed to protect the safety of service users. EVIDENCE: An individualised care plan is produced for all service users based on preadmission assessments but the home need to improve how they are monitoring some of the service users health needs. A lack of recording was noticed for refusal of medication; why certain drugs had been stopped; when supplement drinks should be given; and whether meals were eaten or not. A The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 11 personal hygiene matrix has been included in the care plan, however there were several gaps in this recording, most notably the recording of bathing. A requirement has been added that recording in the care plans must be improved and must be more accurate and comprehensive. The care plans are regularly reviewed but the previous requirement that care plans must demonstrate the active participation of all interested parties has not yet been addressed and is repeated on this report. All comment cards received by CSCI from relatives, health & social care professionals confirmed they are satisfied with the level of care in the home and included the comments, ‘In view of the challenging nature of older people who have dementia the home gives good care in general. But there are some areas that will always benefit from improvement such as skin care/hygiene’. and commented that the ‘since recent management change the xx team have noticed considerable improvement in the care of clients at The Chase’. Health care professionals who were seen on the day of the inspection said the staff were now more open and transparent about what was happening at the home. They are promptly reporting pressure area concerns, and deterioration in health. Staff are now interested what the professionals are doing, are listening to what they were they were saying, and acting on the instructions left. They also said the care had improved, the atmosphere was friendlier and relationships between the Professional teams and The Chase have improved greatly in the past months. One commented that they ‘now enjoy visiting the home where previously they had not’. They said that the standard of care delivered to the service users had improved. One staff member said that some service users did not have baths as often as they should. A service user said that she does have a bath but it does depend on how busy the staff are. There was a requirement on the last report that the home should use the service of the continence advisor to provide appropriate training for staff and advice to service users. Although it was stated that this had happened there was no documentary evidence to support the claim and therefore the requirement has been repeated. Records of medication, received, dispensed and disposed of are reasonable apart from topical creams and supplement drinks. The homes policies for dealing with homely remedies are satisfactory. Staff who administer medication have received the necessary training. Most drugs are properly stored with the exception of some creams, which were observed on bedside tables or the floor in service users rooms. There is no guidance or protocols in place as to when and how creams need to be applied. There is no risk The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 12 assessment in place for service users who administers their own creams and no evidence that the home check that they can manage this task appropriately. The home also has no protocols in place for the administration of ‘when required medications’ and these need to be developed and staff made aware of the guidance. Requirement - The homes policies and procedures for the storage and administration of medication must be improved to include appropriate storage of topical creams; protocols for the application of topical creams; risk assessments for self administration of medication; protocols for the administration of ‘when required’ medications; and improved recording of the administration of supplement drinks and the application of topical creams. Care staff were observed treating residents with dignity and respect and explaining procedures that were being carried out. Staff spoke gently and kindly to the residents and guided and supported service users who needed assistance at mealtimes. All examination and medical intervention is carried out in the service users own rooms, this was confirmed health care professionals and staff. Service users were asked at mealtimes were they would like to sit what they would like to drink. Service user said that ‘the staff often pop into her room for a chat’, ‘the staff are very kind to her’, and ‘that she felt safe’. The staff were observed communicating in ways, which suited the individuals. The majority of the service users indicated by their behaviours that they were feeling OK. The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users social needs are supported through a variety of activities, although the inclusion of outings would further enhance this; visitors are made welcome in the home; and service users are given choices in their daily lives. Additional staffing and consideration of nutritional, religious and cultural wishes would ensure that mealtimes were an enjoyable event for all service users. EVIDENCE: There is an activities programme on display in the foyer but the home do not keep any record or evidence that activities have taken place and a recommendation has been added regarding this. Staff and service users reported that they have entertainment at the home and had recently enjoyed a pantomime. There are visits from the hairdressers and one lady said that she really enjoyed the massages given by the aroma therapist. She said, “I would like more pampering” Service users said that they enjoyed the musical The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 14 entertainment that was provided. Some said that they would like to do more, others said they were happy with what was on offer. Relatives said that they had noticed that staff are doing more with the residents. They said that it was really nice to seeing them playing and enjoying board games. Service user comments included, “the home is pretty good but you don’t do a lot here, I would like to go out sometimes”, and “I like watching what goes on, that’s all I need”. A staff member felt that the service users do not do enough. She commented that ‘the pottery lady has just left’. A previous recommendation that Public information documentation and staff would benefit by information regarding cultural/religious resources has not yet been met and is repeated on this report Visitors confirmed that they are welcomed at the home. They said that ‘there have been significant improvements; they can see their relative in their rooms or in the communal areas; they are now kept informed of any changing conditions; staff are now friendly and welcoming; and they said that ‘they are polite’. A letter from a relative was witnessed thanking the staff for provided an area where he was able to sit and have Christmas dinner with his mother. Those who are able are encouraged to make decisions, choices and have control over their own lives with support and guidance given to those who require it. Choices include where they would like to eat their meals or where to spend time with friends and relatives when they visit. Some choose to see family in the communal areas others in their rooms. The home has 3 smaller lounges/dining areas where service users can sit if they wish. It was observed that some service users were sitting in a small lounge and they confirmed this is where they wanted to spend their time. One service user said that she had chosen the colours for her walls and bedding. She said that she spent most of her time in her room, as this is what she wanted to do, But she had the choice to join in activities and sometimes went downstairs when there was entertainment. There is a 4 weekly menu rota in place offering a choice of menu at lunch and tea. Liquidised diets are all served in separate portions. There is no record kept of food eaten or not eaten or when supplements are given and a recommendation has been made regarding this. A service user commented, “the meals are not too bad and you do get a choice”. However one service user was observed not to eat her meal and when asked said she would have preferred rice. A requirement is made added that food served to service users must meet their nutritional needs and take into account their religious or cultural needs and wishes. It was observed that service users were asked where they would like to eat and what they would like to drink at lunchtime; and that the meal was a slow and unhurried social event. Service users spoken to in the dining room said that they ‘enjoyed the meals provided and had enough to eat’. However there were more service users who needed assistance with feeding than staff The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 15 available to assist and some were left at the table waiting for approximately 30 minutes before being served; most of the other service users had already finished their meal by this time. In addition plates were still on table in a small lounge area at 2.30 pm., indicating that those service users had not been checked for a long period of time. The previous requirement regarding sufficient staff on duty at mealtimes has been repeated. The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their representatives know how to make a complaint to the home, however information about advocacy services could further help them with this. Some delays in investigating complaints and possible abuse could compromise service users protection. EVIDENCE: The home has a clear complaints policy a copy of which is on display in the entrance hallway. Since the last inspection there has been one complaint made directly to the home, which, although over the 28-day deadline, has not yet been resolved for reasons beyond the control of the home; however the complainant is aware of the situation and has indicated that they are happy to wait for the final outcome. Some concerns have also been brought to the attention of the Commission and these have been taken into consideration as part of this key inspection process. Staff and service users spoken to all knew how to make a complaint and staff indicated that they are aware of the whistleblowing policy. There was no information on display about advocacy The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 17 services, and the home are advised to make this information available for service users. The home has clear policies and procedures for protecting service users from abuse and also have a copy of the Kent & Medway Adult Protection Guidelines. New staff are checked against the Protection of Vulnerable Adults register prior to starting work in the home. Staff are trained in adult protection, and the training matrix confirmed that the majority have already had this training. One report had taken a long time to investigate; however, other reported incidents have been investigated very quickly and passed on to Adult Protection where necessary. A previous recommendation that Policies which would apply to Regulation 37 should be amended to specify this has not yet been met and is repeated on this report. The other part of the recommendation has been met. The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25, & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have benefited from recent improvements to the environment, however there is still a lot of work to do to ensure that the home is of the required standard. EVIDENCE: Although a lot of work has been undertaken in the home since the last inspection, there is still a lot that needs to be done to bring the home fully up to standard. The front car park has been block paved to a good standard and is now much safer. The outside area at the side of the house and the back garden still needs attention. Part of the garden has been fenced off to give the service users an accessible garden area. There are still hazards that would of The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 19 risk to the service users in the remainder of the garden, and the area fenced off and available is very small. There seems to have been a misunderstanding on what work needed doing but this has now been clarified. The previous requirement about the garden has been amended and repeated. New carpets have been fitted in the first floor hallway and the upstairs dining area, and the flooring in the lift has been replaced. The flooring in the downstairs ‘blue’ bathroom needs to be replaced and a requirement has been made regarding this. The bathroom that is sealed off behind the laundry room has not yet been opened up and the previous requirement is repeated. The double bedroom identified during the inspection site visit is not large enough to meet the needs of the current service users. It has a window in the door compromising privacy and dignity; there is a fire exit in one corner; there is insufficient room to open the doors of one of the wardrobe’s; there is insufficient space for staff to access both sides of the bed and no room to move the bed; a hoist is used for one of the service users and there is insufficient room to use this safely; and there is only one central light. This room is not considered to be suitable to be used as a bedroom, especially a double room, and should certainly no longer be used to accommodate both of the existing service users. A requirement has been added regarding this. A previous recommendation regarding the lighting of double bedrooms has not yet been addressed and is also repeated on this report. A selection of bedrooms were inspected, two of those inspected have been redecorated, re-carpeted, and refurnished. A good start has been made and rooms are decorated and refurnished to a good standard this needs to be continued throughout the home. Some of the radiator covers are adequate but there are some that are not and need replacing. The home is aware of this and a risk assessment has been done. There are plans in place for the replacement of the covers that do not adequately protect the service users. There was a requirement on the last report that a risk assessment be done to identify the radiators which put the service users most at risk. As this has been completed and a phased implementation has been programmed this has now been reduced to a recommendation. The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 20 No offensive odours were noted in the main home, although a musty/airless smell was noted in the area where rooms 10 - 12 are located; an odour was noted in one room and also in the first floor sluice. A requirement has been made that all areas of the home must be kept clean and free from offensive odours. The floor in the downstairs sluice needed cleaning. Relatives and staff said that the standard of cleaning and hygiene at the home has improved. The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements need to be made to staffing levels to ensure the needs of the service users needs are met. The completion of planned training will help staff to further meet service users needs. EVIDENCE: Staffing levels in the home were observed to be insufficient to fully meet the needs of the service users and a requirement has been made regarding this. Staff commented that they ‘would like to have more time to spend 1:1 with the service users but they are always a bit rushed’ and that ‘the workload is heavy having quite a few double handers’. Currently the home has 17.65 care staff who are trained to NVQ level 2 or above. A further 5 are studying, and additional places are available for a couple of staff to be enrolled on the course. In addition there are 4 overseas nurses, 3 who are doing their adaptation; and one student nurse. In view of The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 22 the training already taking place a recommendation has been made that staff training should continue to ensure that 50 of staff are trained to NVQ 2 or above. There has been an improvement in the recruitment processes in the home since the last inspection. However staff files should be updated to fully comply with the amended Schedule 2 of the Care Homes Care Homes Regulations 2001 and the previous requirement regarding this has been repeated. The staff training matrix indicates that the majority of staff have either attended or are booked to attend training in Adult Protection, Dementia, and mandatory training subjects, however there are still some gaps and a recommendation has been added that staff training should continue as planned to ensure that all staff are trained and up to date with these subjects. A staff member confirmed that they had not yet attended first aid or infection control training. Visiting relatives commented, “they are now employing the right kind of staff now they have sorted them out”. Relatives and service users said, “They are helpful, polite and supportive”, and “They always ask you if you would like a cup of tea”. The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users health, safety welfare, and financial interests are protected. The appointment of a suitable Registered Manager will provide consistency and stability for service users. EVIDENCE: The acting manager who was in post at the time of the last inspection resigned in December and currently the home is being run by the Area Manager supported by a Registered Manager from one of the other homes in the group. The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 24 Unfortunately this home has had several changes in management over the past few years and although the current management is good, it can only be sustained on a temporary basis. Therefore a recommendation is made that the home appoint a new Registered Manager as soon as possible in order to ensure continuity and stability for the service users. A staff member reported that there had been an atmosphere and some conflict at the home, however it was confirmed that management were aware, have dealt with the problem, and things seem to have improved. The company has developed quality assurance strategies since the last inspection. Quality questionnaires are now circulated to service users, representatives, visiting professionals, and staff, and the company’s headquarters collates the results. In addition a variety of regular audits take place. The home has a development plan, which is currently kept at headquarters and a copy is to be submitted to CSCI. A staff member confirmed that they ‘have regular staff meetings’. Only holds small amounts of petty cash are held in the home for service users and the recording of these is in order. These records and the cash are audited monthly. Since the last inspection staff supervisions have been set up and have commenced, however there was insufficient evidence to ensure that all care staff have formal supervision at least 6 times per year as previously required. Taking into account the work already carried out a recommendation has been made regarding this. The home complies with safe working practices. The safety certificates viewed were all in date and relevant. Accident reporting is in order and audits are also undertaken of accident records. All staff receive induction and mandatory training. The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 3 1 X 1 3 2 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15(1) 17 (3)(a) 15 (1) Requirement Recording in the care plans must be improved and must be up to date, comprehensive and accurate. Care plans must demonstrate the active participation of all interested parties, most notably the resident (or their representative) (Outstanding requirements from previous inspections on 30/06/05 and 23/05/06 new timescale) The home must use the service of the continence advisor to provide appropriate training for staff and advice to service users. (Previous requirement from inspection on 23/05/06 new timescale) The homes policies and procedures for the storage and administration of medication must be improved to include appropriate storage of topical creams; protocols for the application of topical creams; risk assessments for self administration of medication; DS0000057129.V320638.R01.S.doc Timescale for action 31/03/07 2. OP7 31/03/07 3. OP8 12 (1) (ab)13 (1) (b) 31/03/07 4. OP9 13 (2) Schedule 3 (3) (i) 28/02/07 The Chase Version 5.2 Page 27 5. OP15 12 (4)(b) 16 (2)(i) 6. OP15 12 (1) (b) 7. OP19 23(2)(o) 8. OP21 23(2)(j) 9. 10. OP21 OP23 23(2)(b) 23 (2)(f) protocols for the administration of ‘when required’ medications; and improved recording of the administration of supplement drinks and the application of topical creams. Food served to service users must meet their nutritional needs and take into account their religious or cultural needs and wishes. There must be sufficient staff on duty at mealtimes to offer assistance as and when required and to ensure that dishes are cleared within a reasonable timescale. (Previous requirement from inspection on 23/05/06 new timescale). The fenced off rear garden area must be made safe and available for service users to enjoy the fresh air and sunshine (part of previous requirement from inspection on 23/05/06 - new timescale) Sufficient bathrooms must be provided to meet the needs of the service users and comply with 1 bathroom for every 8 service users. (Previous requirement from inspection on 23/05/06 new timescale) The flooring in the downstairs ‘blue’ bathroom must be replaced. The double bedroom identified during the inspection site visit is not large enough to meet the needs of the current service users and must no longer be used to accommodate these service users. Consideration should be given to whether this room is suitable for use as a bedroom. DS0000057129.V320638.R01.S.doc 31/03/07 28/02/07 30/04/07 31/03/07 30/04/07 31/03/07 The Chase Version 5.2 Page 28 11. 12. OP26 OP27 23(2)(d) 18 (1) (a) 13. OP29 Schedule 2 All areas of the home must be kept clean and free from offensive odours Staffing levels must be reviewed to ensure that there are sufficient staff on duty at all times to meet the needs of the service users Staff files must be updated to fully comply with the amended Schedule 2 of Regulations (Previous requirement from inspection on 23/05/06 partially met - new timescale) 28/02/07 28/02/07 30/04/07 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 Pre admission assessments should be further improved, as planned, to ensure they are holistic and supply sufficient information on which to base a care plan (Previous requirement reduced to recommendation as work is already in progress to comply) Details of the fees payable and by whom should be attached to the service users contract (Previous requirement reduced to recommendation to reflect work already carried out) The recording of personal hygiene issues should include details of when service users are bathed or showered. The home should keep a record of the activities that service users undertake Public information documentation and staff would benefit by information regarding cultural/religious resources. (Recommendation on previous 2 reports) A record should be kept of food eaten or not eaten and when food supplements are given. 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 DS0000057129.V320638.R01.S.doc Version 5.2 Page 29 2. OP3 3. 4. 5. 6 7. OP7 OP12 OP12 OP15 OP18 The Chase 8. OP25 9. OP25 10. OP28 11. OP30 12. OP31 13. OP36 (Part of previous recommendation from inspection held on 23/05/06) 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 two previous inspections) The covering of radiators should continue in accordance with the planned implementation, and taking into account the risk assessments that have been completed (Previous requirement from inspection on 23/05/06 partially met) The home should continue with its planned NVQ training programme to ensure that 50 of care staff are trained to NVQ 2 or above. (Previous requirement from inspection on 23/05/06 partially met) Staff training should continue as planned to ensure that all staff are trained and up to date with adult protection, dementia, and mandatory training (Previous requirement partially met) The home should appoint a new Registered Manager as soon as possible to ensure continuity and stability for the service users. The home shall continue, as planned and already commenced, to ensure that all staff have formal supervision at least 6 times per year (Previous requirement partially met) (Previous requirement partially met) The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Chase DS0000057129.V320638.R01.S.doc Version 5.2 Page 31 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!