Inspection on 07/06/07 for The Chase

This inspection was carried out on 7th June 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 04/01/07

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 Woolf Unannounced Inspection 7th June 2007 09:20 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.V340024.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.V340024.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.V340024.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). 4th January 2007 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 but are about to reduce their registration to 30; 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 £385 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.V340024.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 a variety of information gained over the past 5 months; comment cards completed by 1 service user, 2 relatives/visitors, and 2 care managers; and a site visit to the home by 2 inspectors lasting 7 hours 25 minutes. The site visit included a tour of the building; inspection of a variety of records; observation of life in the home; and talking with the acting manager and her deputy, a variety of service users, several members of staff, and 2 visitors. What the service does well: What has improved since the last inspection? Several of the requirements on the last report have been complied with. The home has used the services of the continence advisor to provide training to staff and advice to service users. Over 50 of care staff are now trained to NVQ Level 2 or above. Mealtimes have been organised more efficiently so that staff are available when required, and a record is now kept of food eaten or not eaten. The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 6 The rear garden has now been made safe and available for service users to enjoy the sunshine and fresh air. One double room has now been reassessed and is to be used as a single room only. All radiators have now been covered. What they could do better: Pre admission assessments need to be improved. Care plans should be regularly updated with the service user or their representative. There are gaps in recording in the care plans. Service users health care needs are not currently being fully met. There are some medication procedures that need to be improved, and the temperature in the medication room must be maintained below 25oC. Currently there are insufficient activities arranged to meet dementia care needs; and the recording of activities should be improved. There are several areas in the home where there is an unpleasant odour. Some fire doors are being wedged or propped open and these need to be fitted with appropriate self-closing mechanisms. All bedrooms and bathrooms must be fitted with easily accessible call bells. There are a variety of other maintenance and environmental issues shown in the report that should be addressed. The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 7 Staffing levels need to be reviewed; all staff must be trained in the mandatory subjects plus dementia and adult protection; and staff supervision must be increased. The home should appoint a Registered Manager as soon as possible to ensure continuity of care, and stability for the service users. The home should further develop its Quality Assurance systems 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.V340024.R01.S.doc Version 5.2 Page 8 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.V340024.R01.S.doc Version 5.2 Page 9 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): 3. Standard 6 is not applicable in this home Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre-admission assessment of prospective service users is not sufficiently detailed to ensure that their needs can be fully met. EVIDENCE: The pre admission assessments viewed during the inspection site visit were still in the form of tick lists. These do not give sufficient information to form the basis of a holistic care plan. There was a particularly lack of information about dentures, hearing and vision impairment, and funeral arrangements. Previous requirements have been made about pre-admission assessments. The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 10 The requirement was reduced to a recommendation at the time of the last inspection to reflect work that had started. However as sufficient progress has not yet been made this has been reinstated as a requirement on this report. When service users have a care manager a copy of a joint assessment is obtained from the relevant Social Services and this together with the homes pre-assessment is used to form the service users care plan. Contracts are in place and are signed either by or on behalf of the service users. The contracts include the number of the room to be occupied but still do not contain information on the amount payable and by whom. Although there seems to have been some confusion about this the home are requested to include this information. This home does not offer the facility of intermediate care. The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users’ health and personal care needs are not being fully recorded or met by the home EVIDENCE: An individual care plan is in place for each service user. Specific cultural needs are included in the care plan, however it is important that all staff read this information. When asked one member of staff confirmed that she knew the information was in the care plan but that she had not read it. A comment card from a visiting professional included the comment, ‘New care plans are currently being written which are very comprehensive and updated regularly. These contain thorough risk assessments’. Care plans looked at during the The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 12 inspection were not as comprehensive or as up to date as needed and must be improved. Risk assessments and information for staff should be more detailed, especially regarding levels and instructions for insulin dependent diabetics, and guidance to staff for service users with colostomy bags with regard to hygiene, and how to change the bag. Staff need to be much more diligent in recording in care plans. Particular shortfalls were noticed in the recording of weights, personal hygiene, fluid charts, turns charts, promotion of continence charts and activities. There are no permissions in the relevant care plans for bed rails, although risk assessments are in place. The home currently keeps a bath book; this contravenes the Data Protection Act and was discussed with the acting manager on the day of the inspection site visit. Evidence of bathing would suggest that service users are only being bathed once a month at the most, but a staff member commented, “They have a bath at least once a week, some more often”. A requirement regarding improvement in the recording in care plans was made on the last report. This requirement is repeated and the commission will expect this to be met within the revised timescale. There is little evidence of care plan reviews and no evidence of service users or their representatives participating in the formation and review of care plans. A requirement regarding the active participation of all interested parties in the care plans has been shown on the last three reports. This delay is totally unacceptable and the company can expect further action to be taken if these shortcomings are not urgently addressed. At present service users’ health care needs are not being fully met, and a requirement has been made regarding this. Two service users were witnessed to be sitting in dirty wheelchairs. A relative comment card stated, ‘Her dentures have been an issue, they are rarely cleaned’ and ‘Mum has a hearing aid and I feel that some of the staff do not know how to put it in’. Relatives indicated on their comment cards that the home only ‘usually’, or ‘sometimes’ meet the needs of their relative. However service users spoken to commented, “They are looking after me properly”, and “We are well looked after”; and a comment card from a visiting professional included, ‘New manager and staff team appear to be meeting service users needs appropriately’. The home currently has no pressure sores recorded. District nurses are requested to carry out pressure area assessments, and they also provide any necessary pressure relieving equipment. The home has sought the advice of the continence nurse and staff have been trained. Service users have access to the multi-disciplinary health care team and commented, “I have had my eyes tested”, and “I have been to hospital this morning and need to go back in 2 weeks”. Staff members commented, “I participated with the optician”, and “The dentist came last year but have not seen her recently”. There was no evidence in the care plan of an insulin dependent diabetic receiving visits from The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 13 the chiropodist. The home has started to address diversity and cultural needs and have placed an information booklet in the entrance hallway to aid visitors. There are some issues with medication including one drug shown on the MAR sheet but not on the medication sheet in the service users care plan; eye drops with no date of opening on the bottle which could therefore have been 2 months out of date; liquid medication not dated on opening; the temperature in the medication room over the recommended maximum of 25oC; the waste bin in the medication room not being covered; and some external medications being left on display in service users rooms rather than being safely locked away. A requirement is therefore made to cover these issues. Staff who administer medication have attended medication training. A professional’s comment card included, ‘There have been problems (with medication) in the past but the new manager appears to be resolving this’. Staff try to maintain the privacy and dignity of service users and explained how they do this. Service users commented, “I keep my door locked”, and “The girls think they own this room, but I pay for it”. Professionals’ comment cards answered a question about privacy and dignity ‘There have been problems in the past but these now appear to be resolved by the new manager’ and ‘The care service appear to be respecting individuals privacy and dignity’ The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. Additional activities and stimulation are needed to ensure service users’ social and cultural needs are met EVIDENCE: The home has recently introduced a Key worker system and the key workers are working on documenting services users interests and history. Activities that currently take place in the home include, a weekly craft session, visiting musicians, reflexology, manicures, and hairdresser. Staff commented, “I have bought a crossword puzzle book for my key worker resident”, “I would like to take them out more”, and “We are trying to bring in more activities and try to do 1:1’s”. One service user said, “I painted a parrot this week”. A visitor comment card stated, ‘They provide a variety of entertainment for the residents to participate in’, but a service user comment card said, ‘what The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 15 activities??’ A requirement has been made that activities should be increased in line with dementia care needs and that activity recording is improved, including recording of service users interests and 1:1 interactions. A communion service is held every 6 weeks for those who wish to participate. One service user commented, “I have communion in my own room, although I could go to the lounge if I wanted to”. A staff member said “I took one resident to the local church and we stopped for coffee afterwards - we are going to go monthly now”. Currently there are no other religious or cultural services or visitors. There are no restrictions on visiting times in the home. A professional comment card indicated the home is communicating better with relatives; but a visitor comment card stated, ‘I feel more interaction is needed between staff and relatives or friends who come to visit’. One service user commented, “My son bought my flowers”. Service users have choices in their lives which include, where and how they spend their time, what time they get up and go to bed, whether they join in activities or not, their food, and whether they wish to go out in the garden. Service users commented, “I can do what I like”, and “I go out 3 times a week, I go to Bridge on a Wednesday” The home has a four-week menu rota with 2 choices for both lunch and tea and the menus show a reasonable variety. A cooked breakfast is provided where wanted and one service user commented, “I enjoy a bacon and egg breakfast”. The home keeps a menu record showing each service users choice of meal and fluid, whether the meal is finished and comments. The meal on the day of the inspection site visit was nicely presented apart from one individual meal which had been liquidised and was served mixed together. This was discussed with the manager who has undertaken to ensure that in future all liquidised food will be served in separate portions. Service users commented, “The food is not to bad, some days better than others”, and “I enjoyed lunch”. Staff commented, “The food is average, could be better and it would be good if they had a choice of fresh fruit daily”, and “They have cranberry and orange juice” The Chase DS0000057129.V340024.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’ complaints and concerns are listened to and addressed. Efforts are made to protect service users from abuse. EVIDENCE: The home has received 1 complaint since the last inspection. This complaint was investigated and found by the manager not to be substantiated. Comment cards indicate that service users and their families would all know how to make a complaint if it were necessary. A copy of the complaints procedure is on display in the entrance hall. There have been 2 adult protection alerts on the home since the last inspection. Both of the incidents were alerted to the adult protection team by the home. One of these alerts has been lifted and the staff involved have been cleared. The other Adult Protection is still open, the home’s contract with Kent County Council Social Services department is still suspended, and Care The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 17 Managers are making regular visits to the home. The management have made relevant referrals to the Protection of Vulnerable Adults register. Staff have now received training in adult protection. The Chase DS0000057129.V340024.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, 21, 24, & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Unpleasant odours, and required maintenance, mean that service users are prevented from living in a clean, pleasant and comfortable environment. EVIDENCE: Since the last inspection several of the requirements regarding the environment have either been met or work is currently being undertaken. This includes works to the rear garden, which has now been cleared and made safe. It is important, however, that staff remember to keep the gate to the area at The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 19 the rear of the garden locked when they are not assisting a service user on a 1:1 basis. There is also some moss on a path, which will need to be removed. Builders were working on opening up the ‘hidden’ bathroom at the time of the inspection site visit. The double bedroom identified during the last inspection as not large enough to meet the needs of the service users has now been made into a single room and the manager is going to apply for a reduction by one of the numbers of service users shown on the homes certificate of registration. All radiators have now been fitted with appropriate covers. There are several areas where general maintenance is needed. Bathrooms, toilets, and the small lounge need decorating; several toilet roll holders need to be re-positioned to make them accessible to service users; a splash back should be provided in one identified bedroom; the ‘Formica’ top needs to be replaced in one bedroom; the stained flooring around one toilet should be replaced; and the ‘chipped’ bath should also be replaced. A requirement has been made regarding these issues. Staff commented, “the place could do with more TLC”, “I wish we had a proper staff toilet instead of one with a broken seat and no waste bin”, and “we need better equipment for the residents, more grab rails, and better raised toilet seats”. During the tour of the building it was noticed that several fire doors were wedged open and a requirement has been made that fire doors that need to be kept open must not be wedged, but should be fitted with appropriate selfclosing mechanisms. Communal space is arranged in several areas. The conservatory has been rearranged into small sitting areas that are more cosy and friendly than the previous arrangement. Sufficient dining table provision for all service users has been provided, although the tables are a little high and are going to be lowered, and some service users still prefer to eat at overlap tables. Several issues were noted with service users’ bedrooms during the tour of the premises. All bedrooms and bathrooms should be fitted with easily accessible call bells; all bedroom doors should be fitted with locks; each service user should have a lockable facility in their room; one room did not have comfortable seating provided; service users’ furniture must be safe - one wardrobe door was loose and needed fixing, and a knob was coming loose on a chest of drawers. A requirement is made to cover these issues. Infection control is compromised in various parts of the home by having waste bins with no lids. There are also several areas throughout the home where unpleasant odours are still very noticeable. A requirement has been made on the last three reports regarding this and is repeated on this report. The home must make a concerted effort to eradicate these totally unacceptable odours without any further delay. The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 20 The Chase DS0000057129.V340024.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 adequate. This judgement has been made using available evidence including a visit to this service. Service users may be put at risk through insufficient staff and gaps in staff training. EVIDENCE: The current staffing level of 2 care assistants overnight is insufficient to meet the needs of the service users, particularly bearing in mind the levels of dementia, the higher dependency of some service users, and the layout of the building. Although the acting manager stated that this figure would be increased to 3 from the following week it is important that she makes sure that levels do not drop below 3 in future. Evidence also shows that one cleaner each day is insufficient to keep the home clean and fresh. A visitor comment card included, ‘There are times when there is a lack of staff providing help to the residents’; and a member of staff commented, “there are times when there are insufficient staff, but usually there are enough”. A requirement has been made that there are 3 members of staff on duty every night; that additional The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 22 domestic staff are employed; and that staffing levels are kept under constant review to ensure that all of the needs of the service users are fully met. Currently 57 of the care staff have achieved NVQ Level 2 or above, and this figure should increase to 71 when current students complete their studies. Staff commented, “I have NVQ 2”, and “I have NVQ 3”. The home’s recruitment practices are sound. No new member of staff is employed until 2 satisfactory references have been received, an enhanced disclosure has been submitted to the Criminal Records Bureau, and a satisfactory check has been made of the Protection of Vulnerable Adults register. A full employment history is now requested from staff on their application forms. All new staff undertake induction training to Skills for Care specifications. Although there has been a lot of training during the past few months, there are still gaps in some of the mandatory training subjects, noticeably First Aid, Basic Food Hygiene, Infection Control, and Moving and Handling. Almost all staff have been trained in Adult Protection. Most staff have either attended or are booked on courses for Dementia training. A requirement has been made to ensure that all staff are trained in the mandatory subjects plus dementia and adult protection. Staff commented, “I have just done my infection control course”, ”I have done dementia training”, and “I am doing distance learning of Infection Control” Service users comments about the staff included, “The staff try to make life bearable and they understand”, “I like the staff”, and “The staff are good”. A relative comment card stated, ‘The staff are polite and helpful’. Staff said, “I like it here”, and “I’m quite happy with everything at the moment”. The Chase DS0000057129.V340024.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, & 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 is necessary to ensure consistency and stability for service users EVIDENCE: There have been several changes in management in quite a short period of time and this disrupts continuity of care. A service user commented that she The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 24 did not like all of the changes of manager; and a member of staff commented, “The changes in management disrupt the clients, they lose trust”. The home has now appointed an acting manager who intends to submit her application to become the Registered Manager. The acting manager has only been in post for 9 weeks and is therefore only just beginning to get to grips with all that is required in the home. She was a manager at another home previously, and is currently doing her NVQ 4 in care and Registered Managers Award. A Deputy Manager who is also new to the home supports her. The manager receives advice and support from the provider and also from another manager within the Charing group. A service user said, “The manager is nice”. Staff said, “Teri has a good rapport with the clients”, and “We get support from Teri”. Taking into account the current situation a recommendation is made that the home appoints a Registered Manager to ensure continuity of care for the service users. The home has some quality assurance systems in place. Questionnaires are circulated to service users families and a comment from one family on the monitoring results read, ‘Cannot stress enough how happy we are with The Chase. No complaints whatsoever’. The company has a system of regular management audits. Regular staff meetings are held, and the manager stated her intention to start residents meetings, and to further develop the homes quality assurance. Following the discussions with the manager a recommendation has been added that the Quality Assurance is further developed. The home only holds small amounts of petty cash for some service users. The recording of these is in order and the system is regularly audited. Despite assurances, and a reduction from a requirement to a recommendation at the last inspection, staff supervisions are still not taking place at least 6 times a year. The new manager has now drawn up a supervision schedule but as these have not yet commenced a requirement has been made regarding this. The health & safety of service users and staff is protected. Maintenance of installations and equipment is mainly up to date, although portable appliance testing and the legionella certificate have now expired. Risk assessments are carried out for safe working practices. Accident reports are in order and are regularly audited. The Chase DS0000057129.V340024.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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X 1 X X 1 X 1 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 The Chase DS0000057129.V340024.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 OP3 Regulation 14 (1) (a) Requirement Pre admission assessments must be improved to ensure they are holistic and supply sufficient information on which to base a care plan Recording in the care plans must be improved and must be up to date, comprehensive and accurate (Outstanding requirement from previous inspection on 04/01/07 new timescale) Care plans must demonstrate the active participation of all interested parties, most notably the resident (or their representative) (Outstanding requirement from previous inspections on 30/06/05, 23/05/06 04/01/07 - new timescale) Service users health care needs must be fully met. This must include attention to needs with regard to hearing and sight loss, personal care and bathing, and chiropody. Medication procedures must be improved to include date of DS0000057129.V340024.R01.S.doc Timescale for action 01/09/07 2. OP7 15 (1) 01/08/07 3. OP7 15 (2)(c) 01/09/07 4. OP8 12 (1) (a) 01/07/07 5. OP9 13 (2) Schedule 01/08/07 The Chase Version 5.2 Page 27 3 (3) (i) 6. OP12 16 (2) (m & n) 7. OP19 23 (2) (b c & d) 8. OP19 23 (4) (a) 9 OP24 23 (2) (c, m, & n) 10 OP26 23(2)(d) opening on eye drops; dates of opening on liquid medication; ensuring the temperature in the medication room does not exceed 25oC; covering of the waste bin in the medication room; and ensuring that external medication is locked away and not left on display in service users bedrooms. Activities must be increased in line with dementia care needs; and the recording of activities must be improved, including details of service users interests, and recording of 1:1 interactions. Maintenance issues must be addressed including - Bathrooms and the small lounge need decorating; several toilet roll holders need to be re-positioned to make them accessible to service users; a splash back should be provided in one identified bedroom; the ‘formica’ top needs to be replaced in one bedroom; the stained flooring around a toilet should be replaced; and the ‘chipped’ bath should also be replaced Fire doors that need to be kept open must not be wedged but should be fitted with appropriate self-closing mechanisms All bedrooms and bathrooms must be fitted with easily accessible call bells; all bedroom doors must be fitted with suitable locks; each service user must be provided with a lockable drawer or cupboard in their bedroom; every bedroom must be provided with comfortable seating; service users furniture must be safe and properly maintained. All areas of the home must be DS0000057129.V340024.R01.S.doc 01/09/07 01/12/07 01/08/07 01/08/07 01/09/07 Page 28 The Chase Version 5.2 11. OP27 18 (1) (a) 12. 13. OP30 OP36 18 (1) (c) (i) 18 (2) (a) kept clean and free from offensive odours at all times (Outstanding requirement from last three inspections revised timescale) There must be at least 3 members of care staff on duty every night; additional domestic staff must be employed to ensure the home is kept clean and fresh; and staffing levels must be kept under constant review to ensure that all of the needs of the service users are fully met. (Outstanding requirement (expanded) from previous inspection on 04/01/07 - new timescale) All staff must be trained in the mandatory subjects plus dementia and adult protection. All care staff must receive formal supervision at least 6 times a year and all other staff should be supervised on a continuous basis as part of the normal management process. 01/08/07 01/09/07 01/11/07 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. 2. Refer to Standard OP31 OP33 Good Practice Recommendations The home should appoint a Registered Manager as soon as possible to ensure continuity of care, and stability for the service users. The home should further develop its Quality Assurance systems. The Chase DS0000057129.V340024.R01.S.doc Version 5.2 Page 29 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.V340024.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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