Inspection on 06/05/05 for The Chase

This inspection was carried out on 6th May 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 10/11/05

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 Unannounced 06/05/05 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 V225748 060505 Stage 4.doc Version 1.30 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) 01227 453 483 01227 463 483 Charing Healthcare CRH 31 Category(ies) of Care Home for Older People - DE(E) Dementia registration, with number over 65 x 31 of places The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Admission from 9 February 2004 to be restricted to clients over 65 years of age in the registered category DE(E). Date of last inspection 11 October 2004 Brief Description of the Service: This care home has been in existance for some years but Charing Healthcare have owned it since December 2003. 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 onsite 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 V225748 060505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was intended to introduce the new inspector to the staff and residents; to check compliance with matters raised from the last inspection (October 2004); and to reach a preliminary view on the day-to day running of the home. The inspection process took just over eight and a half hours, and involved meetings with five residents (in two cases, separately and one group of three residents), two relatives and one visitor, and the new manager and the deputy manager / head of care. The inspection also involved an examination of records and policy documents and the selection of one resident’s case file, to track their care. The bedrooms in the new wing were inspected for compliance with the National Minimum Standards, and the inspector also checked some communal areas. Interactions between staff and residents were observed throughout the day. What the service does well: What has improved since the last inspection? The most signal progress has been made with the introduction of a new manager on 4th January 2005. Patricia Smith has come to this home with a background in managing other nursing homes (including registration for dementia), setting up new homes, supporting managers, trouble shooting and inspecting homes in the Charing Healthcare Group under Regulation 26. On the day of this inspection, she demonstrated a sound understanding of the practical application of the National Minimum Standards and quality assurance principles and tools (e.g. newsletters, relatives’ group meeting, quality monitoring questionnaire). A number of operational tools were already in place at the time of this inspection and were already under review for their The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 6 effectiveness. An audit of the premises was close to completion and identified a range of opportunities for refurbishment. Some of this work had already started. The new manager and her deputy both broke other commitments outside the home, to meet with the inspector and assist with this inspection, and the time and trouble they each took was much appreciated. Although Patricia Smiths’ role as manager has yet to be confirmed by the CSCI Registration process, a good start had already been made and residents, relatives and staff reported she had made a good impact on the home. Some progress had been made to obtain compliance with matters raised by the last inspection. 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 V225748 060505 Stage 4.doc Version 1.30 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 V225748 060505 Stage 4.doc Version 1.30 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, 3, 4, 5. Standard 6 does not apply 1. Not all the information necessary for potential residents to make an informed choice is available. 2. There is a contract governing each placement 3. Prospective residents’ needs are assessed prior to admission. 5. Prospective residents, or their representatives, have the opportunity to visit to further inform their choice. EVIDENCE: There is a Statement of Purpose, but matters raised by the last inspection for inclusion, had not yet been addressed. There is, moreover, no Service User Guide. The “Residents Welcome Pack” is only partially compliant with the elements of the National Minimum Standard. Feedback from two relatives and one resident confirmed that a couple of other options were looked at but choice was very limited. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 9 Feedback on the day of this inspection indicated that the decision to apply to this home was influenced more by its locality (i.e. close to where the resident or relatives lived) and limitations of the care home sector generally to meet the needs of people with dementia - than by any public information produced by the home itself. The new manager has made some progress with this already by producing a leaflet called the “Residents Welcome Pack”. This document usefully describes aspects of the home, services and facilities, and the level of care overall – and a copy is intended for each resident’s bedroom. A number of other elements listed by this standard will, however, need to be included to obtain full compliance with the standard. No other languages or formats (e.g. tape or Braille) are currently warranted, but the manager does intend making this information available in large print for people with a visual or reading impairment. Most admissions predate the new manager, but she described a systematic process, to ensure a consistent approach. The processed described would routinely involve any care manager or Community Psychiatric Nurse involved, in a joint assessment, and the manager described how she would discuss each prospective placement with staff at the home to check their suitability and the home’s capacity to meet their needs. The family of one of the two residents confirmed having visited the home before their admission. The other resident came with their spouse for a meal before a decision was made to admit them. There is a trial period of up to a month before each admission is confirmed. Each placement is confirmed by a contract. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10. Standard 11 was not assessed on this occasion. 7. The assessment and care planning processes cover a wide range of health and personal care needs, as well as some social care needs 8. The home is served by a range of healthcare professionals, and has adequate facilities for privacy. 9. The home has a comprehensive policy on medication and each individual’s capacity to self administer is subject to risk assessment. The arrangements are safeguarded by a Monitored Dosage System and college training for staff. 10. Observed interactions between staff and residents were respectful during this inspection. EVIDENCE: The format of the care plan, which follows on from the preadmission assessment, is a comprehensive one, clearly designed to address the health and social care needs of the residents. Less clear, however, was the extent to The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 11 which residents were actively engaged in this process, and how the home established the resident’s own perspective and any unmet needs. There was clearly a heavy nursing / physical care bias. The challenge for the home will be to demonstrate the active participation of all interested parties, particularly given the special communication and retention needs of the majority. Managing the behaviour and comprehension of individuals at different stages of onset dementia must be a central theme to this home’s practice, but care planning documentation needs to better reflect the practical steps required to address individual needs. The manager described how she had reorganised the working arrangements, so as to dedicate a team to each of the four units in this home; to set up a Life History for each resident; and to build up the standard of daily reporting so as to better inform the monthly reviews. It was too early to judge the effectiveness of this process, but a good start has been made. The home has access to a range of healthcare professionals and the fact seven GPs 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, but the environment clearly requires much better continence management generally. See section on Environment for further details. The home has a generally comprehensive policy on medication. Two matters were raised for inclusion. See schedule. The home uses the Boots monitored dosage system and one resident has been risk assessed able to manage their own medication. Five residents have diabetes, and one told the inspector how hers was managed with insulin and diet and how the others were managed with diet. The manager said that arrangements had been made with Canterbury College for staff training, but practice and staff competencies were not further assessed on this occasion. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 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 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 limited range of activities inside and outside the home. 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. Meals are well prepared and presented, and staff are readily available to assist residents. Mealtimes are unhurried and the setting is congenial. EVIDENCE: This home offers a limited range of activities on site. Records show that a few residents can be encouraged to participate in ball games, table top activities, board games and movement to music sessions. Taped sing-along music was played throughout the day of this inspection, and residents could occasionally be heard to join in with staff. At one stage they were reported to be dancing too. A couple of residents are assisted by staff to go for walks and some clearly enjoy the garden in good weather. A bi-monthly newsletter announced that a barbecue is planned. There was one outing to a “Music Hall” matinee at the end of March, and an entertainer has been visiting every month. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 13 The home has open visiting arrangements (day and evening) and this was confirmed by two relatives and one visitor. 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. The manager gave examples of friendships struck up between residents, and advised that there were protocols in place to establish capacity and consent in the event of more intimate relationships developing. In terms of choice and control, practice appears to vary between individual members of staff. On the one hand, residents were observed on the day of this inspection, being generally supported to understand what was happening around them and what choices were available to them. With one exception feedback from the residents, relatives and one visitor was that staff were generally kind and caring. One member of staff was overheard trying to kindly persuade one resident to agree to have personal care, withdrawing when the resident aggressively refused and returning to try again at different stages of the day. However, one resident described staff as “bossy” and it was difficult to see how two members of staff with a poor command of the English language could have meaningful interactions with residents in different stages of onset dementia. One other resident became very anxious about having to leave her chosen seat to join the others for lunch in the dining room. Despite assurances that she could dine wherever she wanted, she was found dining with the others after all. When asked about this, she said she had been persuaded this would be more congenial. It was difficult to see why her wishes had not been respected. It was also noted that earlier in the day, when hot drinks and biscuits were being handed out, a member of staff chose the biscuit for this resident and did not offer her the opportunity to choose for herself. When asked why this was so, the member of staff was unable to explain. The arrangements for meals and mealtimes was partially assessed on this occasion. The manager said there is 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. Preferences are established as part of the admission and care planning process in the first instance, and on the day before thereon. The manager said that the cook is keeping a record of options actually consumed by individuals in each case, in line with required practice. The manager said that nutritional screening is done in-house, and this should enable anyone else who is authorised to inspect the records to track and evaluate their nutritional intake. Some residents have special dietary needs which the home is able to meet . A few residents are unable to chew, so the manager said 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. Feedback indicated that, with two exceptions residents, relatives and a friend are generally satisfied with the quality, choice and presentation of meals. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 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 standard(s) 16, 17 16. Residents said they knew who to tell if they were unhappy about any aspect of the care they were receiving, and there is a complaints procedure readily available. The home needs to be more proactive in picking up issues causing dissatisfaction. 17. The home relies on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. Independent advocacy services should be explored. 18. Residents feel well cared for and the manager is a trainer on adult protection. EVIDENCE: The home’s complaints procedure had recently been put 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 are raised for inclusion / amendment. See schedule. Some residents are able to speak up for themselves (when questioned, three identified the staff they would raise complaints with), but most are unable to, in a sustained way. The home does not use any independent advocacy services, but relies on its key worker system, families and friends to raise issues and represent the interests of the less able residents. However, during this inspection, residents, relatives and a friend raised a number of issues – such as continence management, the laundry arrangements, lack of involvement in care planning / reviews, a resident The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 15 wandering into rooms uninvited, personal items going missing, and occasional staff attitudes – all of which could have been usefully pursued through a proactive complaints process, but when asked, the manager said that the complaints register had no entries in it. The manager will need to demonstrate that not only do residents and other interested parties know how to make complaints, but are actively assisted (i.e. through independent advocacy services) to do so. The manager said that those residents who are able to vote, were registered to do so. A few residents were able to attend the polling booths to cast their vote at the last election – others used the postal vote system. This matter was not explored any further on this occasion. There are some volunteer visitors but the question of independent advocacy services should be explored, so that the home can demonstrate that the residents’ interests are being promoted without any question of bias, and that its own practices are open to challenge. In terms of adult protection, the manager said she was a trainer in adult protection but this standard was not otherwise pursued on this occasion. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 22, 23, 24, 26 19. The layout of this home is generally suitable for its stated purpose but the décor is in need of further investment. 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 need of refurbishment 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. Most residents have access to the privacy of their own bedrooms and each bedroom is reasonably personalised. 26. The home is in need of much better continence management. EVIDENCE: The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 17 The location and layout of this home is generally suitable for its stated purpose, although the first impression is likely to be disappointing – the forecourt is in 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. This signals a home, which is in need of substantial refurbishment. The manager was taskedrequested to provide a complete schedule of the home, 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. This matter was raised by the last inspection (October 2004) and found to be still outstanding, though this clearly predated the new manager, and was subsequently provided. Visitors are also likely to be confronted by an unpleasant and pervasive odour of incontinence upon entering the home, which warranted an Immediate Requirements Notice. The new manager was tasked to submit an action plan within two weeks, detailing how this particular matter is to be addressed and how satisfactory standards are to be maintained thereon. This was subsequently submitted. It is accepted that the new manager had already introduced measures to improve the level of hygiene generally by the time of this inspection. The home’s washing machine has a sluice cycle. There are three sluice facilities and regular collections of clinical waste. Residents have a choice of communal areas, and lighting and furnishings tend to be domestic in character. There are homely touches throughout. Most residents (though this is less than 80 ) have access to the privacy of single occupancy bedrooms. Five bedrooms are shared and in each case 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. The manager should 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. When questioned, one resident could not recall being offered a single occupancy room and complained about the other occupant’s disruption at night. However, this did not accord with the manager’s own understanding of events. 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 four bedrooms inspected on this occasion. See Schedule of Required Action. The rooms 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. This should be risk assessed, as a precaution against the risk of accident. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 18 Most bedrooms have commodes but these tend to be very basic, obvious models, which would signal incontinence to any visitor. In one case the commode was clearly beyond deep cleaning and must be replaced. The manager should look for opportunities to introduce more discreet models to accord residents more dignity. 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 refurbishment. Baths have thermostatic temperature control, but basins do not. This is being risk assessed. The grounds to the rear of the property 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 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. Periodic inspections by Environmental Health Officers are also recommended, to ensure compliance with health and safety standards. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 19 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 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: Reliance was placed on the manager’s responses to questions based on the National Minimum Standards on this occasion. These standards will be subject to more robust evaluation at the announced inspection. The manager said she aims to obtain the following staffing levels, which were based on the Residential Forum formula. There was compliance with these staffing levels as described on the day of this inspection. The manager herself works 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. This indicates a waking day of 12 hours – a 14 hour waking day is strongly recommended so that there are sufficient numbers of staff to attend to residents in the evenings. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 20 One should always expect to find a senior and four care staff on duty during the day time, plus kitchen staff (a cook and her assistant). At night there are three waking staff. There are dedicated cleaning staff from 8am till 2pm every day. The manager is looking to recruit more cleaning staff, but students come and do vacuuming duties after school. There is a full time maintenance member of staff. 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. Three staff who do not have NVQ accreditation are, however, RGN qualified. Six 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 updated last month. 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). It was too soon to judge the effectiveness of this management approach, but this will be subject to a more robust inspection at the announced inspection. The manager gave an assurance that staff providing personal care to residents were at least 18 years of age and that staff would not be left in charge of the home unless they were at least 21 years of age. The manager also gave an assurance that the recruitment process was thorough – that it systematically required two references, satisfactory checks of the Vulnerable Adults and UKCC registers, and that each member of staff were given copies of the GSCC Code of Practice. One matter raised at the last inspection – a review of the status of all existing CRB checks – was, however, reported to be still outstanding and must be completed as a priority. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 21 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. Early indications are that the new manager has made a good impact on the day to day operations of this home, and has already arranged for a full audit of the premises, and a range of service improvement initiatives, with more planned. 32. Staff and residents clearly appreciate the impact of the new manager, and her experience assessing other homes in the group against the provisions of Regulation 26 should enhance the level of corporate accountability. 33. A number of Quality Assurance tools are already in place or in prospect, which should place the residents’ interests at the centre of the home’s operations. EVIDENCE: Reliance was placed on the manager’s responses to questions based on the National Minimum Standards on this occasion, but some supporting documentation was made available, which are detailed in the text below. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 22 Patricia Smith has been in post since 4th January 2005. She reports having already obtained the relevant nursing and management qualifications, and has at least two years’ experience in senior management. She will have to undergo the CSCI formal registration process in respect of this home. Ms Smith provided a range of examples of operational and quality assurance tools for inspection, either already in place or in prospect. Examples included: Quality Monitoring Questionnaires, which should provide a useful source of feedback comments for publication in the Service User Guide; environmental audits, which commit the organisation to practical action plans and timeframes; meetings with relatives (one group meeting was not successful so timing is being reviewed) and one-to-one meetings with residents; regular bimonthly staff group meetings (there have been two so far) to increase ownership of policies as well as to discuss operational matters). The manager’s experience carrying out Regulation 26 inspection visits across the group of homes should provide an invaluable source of networking good practice. it is too soon to reach any firm findings on these issues, but a good start has been made. There are clear lines of accountability within the home and within Charing Healthcare, although the challenge for the organisation will 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 Standard. 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. This home was last assessed for its fire safety measures in April 2002, and found to be generally satisfactory, but one matter was raised for attention - a fire risk assessment for the premises – was found to be still outstanding. This must be submitted to the Fire Authority (and copied to the CSCI) without further delay, as evidence of due diligence. Periodic assessments by an Occupational Therapist, to ensure it maintains its capacity to meet the needs of the residents. Periodic inspections by Environmental Health Officers are recommended, to ensure compliance with health and safety standards. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 23 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 1 x 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 3 2 2 2 2 2 1 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 2 x 3 3 3 x x x x 2 The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 24 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, 5 & Schedule 1 Requirement Prospective residents (or their representatives) must have all the information they need to make an informed choice about where to live. this is to be interpreted as a Statement of Purpose and Service User Guide which are fully compliant with the elements of this standard 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 Complaints Procedures.The procedure needs amendment to advise prospective complainants that they may contact the CSCI at any stage. The policy needs to be detailed in the Statement of Purpose (Reg 4, referring to Schedule 1), and, in summary form, in the Service User Guide (Reg 5). Bedrooms. One commode was beyond deep cleaning and must be replaced. An audit of bedroom furniture Timescale for action 30 06 05 2. OP7 15 30 06 05 3. OP16 22 & Schedule 4 (11) 30 06 05 4. 5. OP24 OP24 16(2)(j) 16 (2) 30 06 05 30 06 05 Page 25 The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 6. OP26 16(2)(k) 7. OP29 Schedule 2(8) 8. OP38 23(4) and fittings needs to carried out, to assess compliance with NMS 24.2, and an action plan needs to be submitted to the CSCI detailing action to be taken (including timescales) to obtain compliance or justification for non provision through properly consulted and documented risk assessment. An Immediate Requirements Notice was issued, which requires the manager to submit an action plan within two weeks, detailing how satisfactory standards of incontinence odour are to be obtained and maintained thereon. A review of the status of all existing CRB checks on staff must be completed as a priority. This matter was outstanding from the last inspection (October 2004). A fire risk assessment for the premises must be submitted to the Fire Authority (and copied to the CSCI) without further delay, as evidence of due diligence. This matter was outstanding from the last inspection (October 2004).. 31 05 05 30 06 05 30 06 05 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 OP9 Good Practice Recommendations Medication Policy / Procedone. two matters are raised for attention: one reference to the NCSC needs to be updated to the CSCI and medication administration records should identify any allergies or mark the relevant section as currently not applicable The Complaints procedure should make it clear that H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 26 2. OP16 The Chase 3. OP16 4. 5. OP21 OP23 6. OP24 7. OP24 8. OP24 9. OP25 10. OP38 serious complaints are events which the home has a duty to report to the CSCI (Regulation 37) The manager be in a postion to demonstrate not only that residents (or their representatives) know how to make a complaint but are actively supported (e.g. through independent advicacy services) to do so. There should be shower facilities, so that residents have a choice and many facilities are reported to need refurbishment. The manager should look for opportunities to reconfigure the layout of shared bed 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 manager is asked to provide a complete schedule of the home, detailing the measurements of each room, its designated purpose and the proposed refurbishment programme, with timeframes, so that the CSCI can assess compliance with the National Minimum Standards and keep track of the refurbishment plan. This matter was raised by the last inspection (October 2004) Bedrooms.. The manager should look for opportunities to introduce more discreet models of commodes, to accord residents more dignity. Ceiling hung curtains in shared rooms, if left drawn, effectively deprive the second bed of natural daylight from the window. The manager should look for opportunities to reconfigure the layout of these rooms to obtain a more equitable arrangements, or consider their conversion to single occupancy, so that privacy can be obtained without compromise on other standards. Commodes. The manager should look for opportunities to introduce more discreet models to accord residents more dignity and one commode was beyond deep cleaning and must be replaced. Ceiling hung curtains in shared rooms, if left drawn, effectively deprive the second bed of natural daylight from the window. The manager should look for opportunities to reconfigure the layout of these rooms to obtain a more equitable arrangements, or consider their conversion to single occupancy, so that privacy can be obtained without compromise on other standards. The design of the radiator guards does allow for hand contact, which may not be in the best interests of confused residents. This should be risk assessed as a precaution against the risk of accident. Periodic assessments of the premises by an Occupational Therapist, are recommended, to ensure they maintain their capacity to meet the needs of the residents H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 27 The Chase 11. OP38 Periodic inspections by Environmental Health Officers are recommended, to ensure compliance with health and safety standards. The Chase H56-H05 S57129 The Chase V225748 060505 Stage 4.doc Version 1.30 Page 28 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. 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