Inspection on 08/12/08 for The Chase

This inspection was carried out on 8th December 2008.

CSCI found this care home to be providing an Adequate service.

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 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 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 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Chase 53 Ethelbert Road Canterbury Kent CT1 3NH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 0 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: The Chase 53 Ethelbert Road Canterbury Kent CT1 3NH 01227453483 01227463483 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Purelake (Chase) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 31 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 31 The maximum number of service users to be accommodated is 31. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home Up to 31 older people can make their home in The Chase (the Service). Its specially arranged so that people who have difficulties with understanding things and with saying what they want, can be comfortable and safe. The building is a large detached older property. There is a large enclosed garden at the front. The accommodation is on the ground and the first floors. There is a passenger lift between the floors. When full, five of the bedrooms can be shared by two people each. In practice, only four are used in this way. All the rest of the bedrooms are singles. Each bedroom has a private wash hand basin. Four bedrooms also have a private toilet and one also has its own bath. Each bedroom has a call point. This means that people can ring for assistance. There is Care Homes for Older People Page 4 of 34 Brief description of the care home also a television aerial point. There are several lounge/sitting areas and there are enough bathrooms and toilets. The Service is set back a bit from a residential road. Its not really within easy walking distance of any shops. There is a bus stop near by and the train station is about one mile away. The Registered Provider is a private company. It runs a number of other residential care services in the general area. People who want to find out more about the Service and about the fees charged, can speak with the Manager. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 1 Star. This means that the people who use this Service experience adequate quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was an unannounced Key Inspection. We arrived at the Service at about 9 oclock and were there for about eight hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with the Responsible Individual. She is one of the Directors of the company that owns Care Homes for Older People Page 6 of 34 the Service. Because of her role, she is accoutable in law to us for how things are going in The Chase. We also spoke with the Manager of the Service. Other people we spoke with include a senior care worker, three care workers, the cook, the laundry manager and one of the housekeepers. We spoke with five of the people who live in the Service and we spent time in the company of others. We walked around parts of the accommodation and we looked at a selection of key records and documents. What the care home does well: What has improved since the last inspection? What they could do better: Quite a lot of the paperwork is complicated and longwinded. This might make it difficult for people who live in the Service to fully take part in deciding things that are about themselves. The range of social activities on offer is a bit limited. Some people might like to do new and different things. The complaints procedure is not user friendly. People who live in the Service will find it difficult to unravel. Parts of the accommodation look shabby. Some of the bedrooms have a stale atmosphere. These areas are not homely or welcoming. The system for finding out what security checks are needed is not thorough enough. Care Homes for Older People Page 8 of 34 This might mean that something important gets overlooked. Someone might be employed who shouldnt be. The quality assurance system doesnt really involve the peole who live in the Service. This is important because they are the experts on what it is like to live in The Chase. They need to have a direct say in how things are going. Also, they need to be told what is going to be done to respond to any improvements they may come up with. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 3 and 6. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods are helped to go back home. Evidence: The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving into The Chase is the right thing for them. She also talks with family members and with people like care managers (social workers). This is done so that she can build up a really good picture of how the person can best be supported. After she has got all of this information, she can then decide if The Chase can meet the persons needs for help. We looked at the information that has been collected for one person who has recently Care Homes for Older People Page 11 of 34 Evidence: moved into the Service. We wanted to see what sorts of things were considered. There is lots of useful information. There is stuff about practical things such as the help needed in the bathroom. But there is also other information about quality of life things. Such as how the person needs to be helped to dine in a special way. The Manager says that the information she gets is shared with care workers. This is done so that they know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days while they get to know them better. The Manager recognises that moving into a residential care setting is a big step for anyone to take. She says that she wants to do everything posssible to put the persons mind at rest. We agree that this is really important. She says that as part of the assessment process people are invited to visit The Chase. This is so that they can see what the place is like first hand. She says that during these visits people can ask any questions they want. Sometimes, the person cant really visits themselves. when this happens, their family is encouraged to go and have alook around for them. There are some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. People can stay for shorter periods of time, although this doesnt happen very often. These shorter stays might be because someone who supports them at home, needs some time to themselves. The Manager says that careful attention is given to helping people go back home. This is done so that their stays do not last longer than is necessary. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10. People are provided with the personal and health care they need. Some of the paperwork is complicated and not user friendly. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to staff so that they know what to do. The Manager says that the plans have been considerably improved. She says that they are more detailed and more organised than they were before. We looked at four of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. Care Homes for Older People Page 13 of 34 Evidence: In more detail, one person finds it helpful to be encouraged to not dwell too much on the recent past. Another person finds it difficult to say what they mean. They have to be given plenty of time. Also, what they say has to added to by seeing how they are in themselves. We asked three care workers about some of these things. We wanted to know what all of this written information means in practice. Whether its used or not. They know all about it and we saw them using it in practice. For example, they are patient with the person who finds talking difficult. They know what the persons saying even though its not that obvious. Then they check out that they have understood them right. The plans are kept up to date so that they are accurate. This involves care workers making daily notes about how things are going. There are then monthly reviews where the Manager checks out whats what and sees if any of the plans need to be altered. Once a year there is a more organised review. This is usually attended by the care manager. All in all, theres a lot of written information and staff are spending large amounts of time writing things down. This then results in there being lots of complicated looking paperwork to wade through. The Assessement says that the whole process is person centred. Were not so sure about this being completely right. Unfortunately, nearly all of individual plans of care are written in a management style. As such, its very unlikely that the people who its written about will find it easy to use. Or interesting enough to want to spend time on. Were not surprised to hear that people dont really bother about it that much. This is a pity because its all about them. The Manager says that she will start to work on a new way of presenting the information. This will use things like pictures, drawings and photographs. All sorts of things to make the information come alive. This stands a much greater chance of engaging people in decisions that are being made about the support they receive. We think that this is a really good idea. She hopes to complete this by 1 July 2009. Sensible steps are taken to ensure that people dont have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a care worker so that they dont lose their balance. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, a number of people have seen their doctors, some on more than one occasion. There have also been visits by other professionals such as district nurses and chiropodists. None of the people manage their own medication at the moment. This is because they Care Homes for Older People Page 14 of 34 Evidence: are not that interested in it. Or because they are not able to do so. Staff do it for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is given. We examined three sets of these records. They are correctly completed. We looked at two medicines in more detail. We did this to see if the remaining stock matches what should be there. Again, we found things to be in order. We asked a number of people what they think of the care workers. They praise them saying that they are courteous and attentive. One person summarises the general mood when they say, I like the staff, you can talk to them and we get on well. Its okay here really. Care workers are relaxed and informal in how they are. Things are orderly without being too much so. When people want to use the bathroom, they are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. There are some interesting things for people to do, but some of them might want to do more. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: There isnt an activities coordinator as such. This means that care workers have to organise social things for people to do when theyve finished all of their other duties. Things are very busy in the mornings and so most of these activities take place in the afternoon. When we were there in the morning, we saw people sitting quite alot. They didnt seem to be enagaged in anything much that was happening around them. The afternoon in the lounge was more lively. Two people were doing a jigsaw with one of the care workers. Two more people were doing some artwork. There was quite a hum of conversation in the room. Most people, but not all, were much more part of things in general. In addition to the regular afternoons in the lounge, there is an artworker who comes to Care Homes for Older People Page 16 of 34 Evidence: the Service each week and there is an aromatherapist who sees some of the people. The Manager says that there are outings, but in reality these are not happening that often. We wanted to know what all of this adds up to. Are people having enough opportunities or would they like to do more? We asked several people about this. Most say things are okay or theyre not sure either way. One person is more definite. They say, its okay, I get a bit bored you know with the tele but theres not much else to do really. We looked at the records of who is doing what. Its a mixed picture. Some are doing more that others. But in general theres not that much being done. For example, one person over a recent period of 18 days did six recorded activities. And some of these are a bit routine such as having their nails cleaned. Another person over the past six or so months has only done six recorded activities. And two of these were having their nails done and one was watching television. There is a balance to be struck between people being able to do interesting things and not being jollied into doing what they dont really want to do. Were not sure that the balance in The Chase is right at the moment. We think that more might need to be done. We have asked the Manager to speak with each person to find out if they would like to do new and different things. She is going to do this by 1 April 2009. We are pleased to note that the Assessment says that it is hoped to appoint an activities coordinator in the New Year. We think that this will come at the right time. This is because she can take forward any ideas that people come up with about new things to do. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. The Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids conflicts of interests. These can sometimes lead to complicated misunderstandings about who has the right to do what. Instead, most people get help from members of their family or from the local authority. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. One person summarises the general view when they say,the grub is good. Theres enough of it and its good. Care Homes for Older People Page 17 of 34 Evidence: The main meal of the day is lunchtime. This is served at about half past twelve. The main dishes are things like fish and chips, poached fish and mince and bacon in herb sauce. Breakfasts are from about 8 oclock and most people have things such as cereals and toast. There is a cooked tea with things like cheese omlette and beans on toast on the menu. There is a choice of dish at each meal time. We looked at the records of the meals provided over a two day period. We wanted to see if people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is reasonable balance. Care workers say that people can have drinks and snacks throughout the night if they want them. This is a good idea. Otherwise, it can be a long time for some people to have to wait between their late evening milky drink and breakfast the next day. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18. The complaints procedure is not user friendly. People are safeguarded from being bullied or taken advantage of. Evidence: We asked people about making complaints. No one has felt the need to do this so far. They indicate by their relaxed manner that they will feel quite okay about doing so should there be a need in the future. There is a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. Unfortunately, the procedure is not written in a user friendly way. This mean that most of the people who live in the Service wont really find it that useful. Theres not much point having a procedure about making complaints if people who live in the Service find it hard to understand. The Manager is now going to do a much more user fiendly version. She is going to use pictures and things like that to say what needs to be said. She is going to do this by 1 April 2009. The Registered Provider has received one formal complaint since our last inspection visit. We looked at how well this was sorted out. The Manager found out the facts about what had happened and she explained these to the person who made the complaint. She was open about some of the things that could have been done better. Care Homes for Older People Page 19 of 34 Evidence: And she changed some of the things that care workers do to make sure that there are no similar problems in the future. For example, on this occasion she made sure that someones electric razor is checked to make sure its clean. Its very important that people are confident that they are safe from being taken advantage of. For example, that theyre not going to be bullied or pushed around. The Assessment commits the Registered Provider to guarding against this. We asked some care workers about this matter. They know what to look out for. Things that might show that somethings not right. None of them have any concerns about how things are going. The people who live in the Service say and indicate that they feel safe in The Chase. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19, 22, 25 and 26. Some parts of the accommodation are a bit run down. Some of the bathrooms and toilets are rather bare. There are some fire safety things that need to be sorted out. There are things to help people get about. There are some problems in the laundry. Evidence: On the outside, the building is generally well maintained. On the inside, the lounges and most of the bedrooms are homely and comfortable. However, the entrance area and the hallways are not up to scratch. They have bare painted walls and over time these have got marked and dented. Most of the doors have scrape marks on them. All in all these areas look tired. They need to be redecorated. The bathrooms and the toilets are rather bare. More could be done to make them into welcoming spaces. Things such as pictures and plants might make a real difference. Theyre clean in general. Having said this we did notice that the plughole in one of the baths is dirty. Its stuffed up with bits of hair and what looks like shampoo. The Manager says that its only recently happened but we dont really accept that. She says that the plug hole will be cleaned without delay. Care Homes for Older People Page 21 of 34 Evidence: The premises are fitted with an automatic fire detection system. This provides a high level of fire safety protection. It is understood that the Kent Fire and Rescue Service says that the system meets the national standard. The Registered Provider has done something called a fire risk assessment. This means that it has looked around the Service to make sure that there is nothing that might reduce the level of protection in place. We looked at the assessment. It says that things are okay. However, its not as detailed as some assessments are. We have asked for it to be sent to the fire brigade people. This is so that they can check it against the things should be covered. The Manager is going to do this by 1 April 2009. The local Department of Environmental Health inspected the kitchen in May this year. The Service was given three our of five stars. The report say that this means that there is a good level of legal compliance. However, there are two more stars to be had. The report says that some improvements are needed before these can be awarded. These include things like cleaning the extractor vents thoroughly and cleaning some grime in the larder. The Manager says that all of the things have been done. We checked the larder and it looks okay to us. The kitchen is clean and well organised. Theres lot of stainless steel surfaces that are easy to clean. However, the kitchen doesnt have a grill. So things like cheese on toast have to be finished off in the microwave. This must make the bread go a bit soggy. The cook does sensible things to ensure good food hygiene. For example, once food is opened it is covered. Then a date is written on it to make sure that things are not allowed to hang around too long. He regularly checks the fridge and the freezer to make sure that they are cold enough. He also checks to make sure that hot foods are properly cooked through. People who need it are helped to get about. There are banister rails in corridors. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There is a passenger lift that gives step-free access around the accommodation. Some people need help in the bathroom. For them there is a walk in shower. There are baths that have fixed hoists. This means that someone who has difficulty standing can sit down in special chair. This then mechanically lifts in and out of the bath. Some people also need help in their bedroom. There is a mobile hoist that can be used there. There are also special things that can be used when helping people get into and out of chairs and things to help them change position in bed. At least three of the bedrooms dont have a fresh feeling to them. The carpets have got stale and this cant be sorted out even though they are washed regularly. Its very important that people can have their own space that is a pleasant place to be. Given this, were a bit puzzled that this problem isnt mentioned in the Assessment as something needing attention. We think that this problem really will need to be sorted out. The Responsible Individual has said that this will now be done by 1 March 2009. Care Homes for Older People Page 22 of 34 Evidence: We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. The radiators are fitted with guards. This has been done so that there is less chance that someone will burn themselves if they fall against them. The accommodation was comfortably warm when we were there. However, the Manager has noticed that two bedrooms in particular can be on the cool side. She says that there is no obvious reason for this. The radiators there are working okay. We have asked her to keep a careful eye on this so that extra heating can quickly be put in should it be needed. The Manager says that nearly all hot water taps are fitted with thermostatic valves. These are designed to reduce the temperature to a level that is not likely to scald someone. We tested a few taps and the temperature seems alright to us. The taps that dont yet have the valves are on a couple of wash hand basins. The Manager doesnt think that these pose an immeduate risk to anyone and she says that the valves are going to be fitted by 1 April 2009. Some of the bedrooms have locks on their doors. Some dont have any. The ones that do, have the sort of locks that you see on toilet doors. They look a bit odd on a bedroom door because of the vacant/engaged signs showing on the outside. Also, they cant be locked from the outside. So theyre only of limited use really. People should be able to lock their doors when theyre not in their bedroom if they want to. We have asked the Manager to speak with everyone to see if they would like to have this sort of lock on their bedroom door. If anyone does, these are going to be fitted by 1 July 2009. Weve agreed to this quite long timescale, because we realise that there are costs involved. We really do want to get the stale odour problem sorted out first. The laundry has a commercial grade washing machine. This has an extra cycle for items that need an especially hot wash. There are also two large dryers. When we were there, one of dryers wasnt working. There was a large build up of things waiting to be dried. The laundry manager said that he isnt sure how this can be done without the second dryer in use. The Manager says that everything will be okay. This is because some of the items can be dried when the night staff are on duty. She says that an engineer has been called and that that second dryer should be fixed soon. We asked care workers about if people are short of things to wear and if there is enough bed linen to use while the second druyer being sorted. They dont feel that theres a problem with this. New rules have been brought out to make sure that used water from the washing machine and from the dishwasher doesnt leak back into the main pipework. It looks like the Registered Provider already complies with the rules. However, to double check Care Homes for Older People Page 23 of 34 Evidence: this the Manager is going to contact the local water supply company. Shes going to do this by 1 April 2009. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30. There are enough staff around. There are some shortfalls in the recruitment system. Care workers know what they are doing. Evidence: From early in the morning until after lunch there are four care workers around. The number then reduces to three for the rest of the day and at night. During the day there are other staff around. For example, there is the cook and there are housekeepers. We looked at the written roster for a recent period of seven complete days. All of the shifts are being filled. The Manager says that there are two vacant care worker posts at the moment. So far she has found it difficult to recruit to these. The shifts that these posts would normally cover are being filled by other care workers doing overtime. There is also some use of agency staff. These people are care workers who are employed by an agency. They can be sent on request to any one of a number of residential care services. This means that inevitably they cant know the people who live in The Chase as well as the normal care workers do. Also and with the best will in the world, they cant know as much about how things are done in The Chase. All in all, agency staff sometimes arent as Care Homes for Older People Page 25 of 34 Evidence: much help as youd think. The Manager recognises this and hopes to keep her use of agency staff to a minimum. Its very important that only honest and trustworthy people are employed as care workers. With this in mind, the Registered Provider completes a number of security checks on new care workers. These include things such as confirming their identity and doing a police check. We looked at the records for two care workers who have been appointed since our last inspection. Most of the required checks have been completed. However, we cant be sure that others arent needed. This is because the record of the jobs the two people have had in the past arent detailed enough. The Manager is going to sort this out by 1 February 2009. She is going to check back to make sure that other security things arent also needed for the other care workers. She is going to do this by 1 April 2009. New care workers receive introductory training before they work on their own. We asked two care workers about their introductory training. They say that it was very useful. They say that they were introduced to the people who live in the Service and that they were told about each persons needs for support. People complete a workbook where they look at all sorts of relevant things. Such as how to safely help people who have difficulty getting about and how to help people who have problems speaking for themselves. we looked at one of these workbooks to see how well its being completed. The work we saw is detailed and clear. We think its very good. The Manager says that after their introduction, care workers are provided with ongoing training. This is designed to develop further their ability to provide a high quality residential care experience. The subjects covered include things like keeping people safe, good food hygiene and basic first aid. We looked at some of the records of this extended training provided for care workers. These show that most care workers have done most of the courses. There are one or two gaps but nothing too serious. The Responsible Individual is going to take a fresh look at all of this training. She wants to have a clearer idea of what benefit staff are getting from it. As a first step, the Manager is going to review what skills and knolwedge each care worker actually has. She is going to do this using the workbook we have already mentioned. This information will then be used to decide what training courses they might need to do in the future. We think that this is an excellent idea. This is because it will focus on what care workers actually know rather on than the courses they have gone along to. And because it will build upon the skills that they really need and have to use if they are going to be able to successfully support the people who have made The Chase their home. The Responsible Individual and the Manager hope to see this review done by 1 July 2009. We think that this is a reasonable timescale given the amount of work they Care Homes for Older People Page 26 of 34 Evidence: will have to do. There is a total of 15 care workers. Of this number, eight have completed a National Vocational Qualification (NVQ) at Level 2 or 3 in health and personal care. Five more are on with doing one of them. These qualifications are a very good idea. This is because they help care workers to deliver high quality residential care services. We spoke with three care workers to find out about various bits of what they know. They know a lot about how each of the people who use the Service like to be supported. They also know about important points of detail. For example, they know about helping older people to take care of their skin and about the important contribution good hygiene makes to health and safety. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35, 36 and 38. Things are well managed. But the Manager isnt registered with us. People are asked what they think, but this needs to be a bit more organised. People are helped to buy what they want. There are sensible health and safety things. Evidence: The Manager runs things on a day to day basis. She has a detailed knowledge of how things are going. When we ask her questions about points of detail she pretty much knows the answers. She doesnt have to fiddle about looking for things or asking other people. This is a good sign, because someone senior needs to be in charge and on top of things. The Registered Provider has not yet asked us to register the Manager in her post. This is important because we need to have the opportunity to have a through look at what she is doing and what she hopes to achieve in the Service. The application is now considerably overdue. We will need to receive it by 1 Janaury 2009. Care Homes for Older People Page 28 of 34 Evidence: If we dont, we will have to think about taking enforcement action. The care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. There are team meetings every now and then. We looked at the records of the last ones that were held in August and September this year. Lots of useful things were discussed. For example, how to make sure that care workers use their time in the best way. So that people dont have to wait for a particular care worker to be free before they are helped. Its really important that the people who live in the Service have their say on how things are going. After all, theyre the experts because they live there. There also needs to be a system for getting what staff think. This is because they know in detail how things work in practice rather than in theory. At the moment, most of the Registered Providers efforts are focused on finding out what relatives think. They are sent a questionnaire each year and then the results are used to do a quality report. The most recent report is still being written up at the moment. However, we were able to have a look at some of the information that will be going into it. In general, the relatives are painting a mixed picture. For example, when asked about the cleanliness of the bedrooms 57 said average and 36 said good. Or when asked about care workers communication with people who live in the Service, the answers were 36 average and 57 good. When asked are there enough socal activities, 50 said average and 30 said good. The Area Manager and the Responsible Individual call to the Service regularly to see how things are going. We looked at the records that they do. Wanted to see what sorts of things they look at. Theyre looking at sensible things such as whether or not fire safety checks being done, what accidents there have been and how up to date the individual plans of care are. All of these things are useful. But its not quite what we mean when we talk about quality assurance. In the case of The Chase, we mean having a system that uses a number of imaginative things to give everyone who lives there the chance to say what they think about their home. It also means having a way to tell people what is going to be done to introduce any improvements that may have been suggested. The Manager and the Area Manager say that they will look into this so that the quality assurance system can be developed in the way needed. This will also include further steps being taken to ask members of staff to contribute their experiences of what it is like to work in the Service. This is going to be done in time for us to be told about the results of all this when the Registered Provider sends us its next Annual Quality Assurance Assessment in 2009. Care Homes for Older People Page 29 of 34 Evidence: The Assessment that we have at the moment is a bit disappointing. Some of the sections arent completed at all. Others are, but they dont give much detail. You cant pick the Assessment up and get a really good idea about how things are going. We will expect the next Assessment to be much more detailed. The Manager and the care workers help people to manage their personal spending monies. They have been asked to do this so that money doesnt get lost. Also, so that each person has enough money to buy the things that they want. The system involves staff holding small amounts of money for people and then using it to buy things for them. For example, paying for toiletries of paying for someone to see the visiting hairstylist. The system needs to be clear and well recorded to show that everything is above board. We looked at the records for one person. These show that reasonable things have been paid for such as the person seeing the aromatherapist and the chiropodist. The individual amounts spent add up and the paper balance tallies with the cash balance. Everything seems to be okay. Regular checks are completed to ensure that the Services fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. More detailed checks are completed every now and then by an engineer. There are regular fire drills. However, these are not really unannouced. Its important that they are. This is because people need to know how to react in a real life situation. The Manager is going to start having unannounced drills by 1 January 2009. There is also an annual fire safety lecture when staff are shown again what to do if the alarms go off. This again is very important because it double checks that everyone knows what they need to. Because of this, the training will now need to be provided more often. The Manager is going to start this by 1 February 2009. There are up to date reports from engineers about the gas appliances, the electrical wiring, the hoists, the lift and the call bell system. These say that they are safe to use. However, some improvements to the electrical wiring have been recommended and the Manager isnt sure whether or not these have been done. She is going to check this out so that any remaining improvements can be completed by 1 June 2009. We looked at the record of accidents that have occurred in the Service since the last inspection. There have been quite alot. But most have been minor bumps and bruises. The Manager and the Area Manager keep an eye on who has had an accident and what happened. This is done so that they can do something if there is a particular problem that causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. Care Homes for Older People Page 30 of 34 Evidence: The Manager says that the handyman checks the premises each week. Hes looking for things that arent working right and for things that might cause someone to have an accident. The up to date records werent there for us to see. The handyman wasnt there so we couldnt check out details with him. All we could do was to look at some of his old records. They show that he looks at down to earth things. For example, are light shades clean, are electrical fuses blowing all the time, are bannister rails secure and are tumble drier vents clear. There were some more up to date records. These show that things that are in place to stop windows opening too wide are working okay. The Manager says that there are no obvious hazards around the premises. For example, seh says that things like bleach are stored out of harms way. So that its not mistaken say for something you can drink. We didnt notice any particular hazards that might cause someone to have an accident. Care Homes for Older People Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 26 23(2)(d) All areas of the Service must 31/03/2008 be fresh and clean. Care Homes for Older People Page 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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