CARE HOMES FOR OLDER PEOPLE
The Chimes 83 Park Road St Annes Lancashire FY8 1PW Lead Inspector
Mrs Lillian McMullen Unannounced Inspection 31st October 2005 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 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 Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Chimes Address 83 Park Road St Annes Lancashire FY8 1PW 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) 01253 725146 01253 725146 theshimes@btconnect.com Mrs Margaret Elaine Brady Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (19), Physical disability (1) The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 21 users to include: Up to 19 service users in the category of old age not within any other category (OP) One named service user in the category of Physical Disability (PD) and One named service user in the category of Mental Disorder (MD). 6th June 2005 Date of last inspection Brief Description of the Service: The Chimes Care home provides residential care for up to 21 older people. It is situated close to the centre of St Annes. Leisure amenities are close by as well as local shops and public transport system. The home is on three floors and there is a passenger lift is in place. There are a number of aids and adaptaions in place throughout the care home suitable for the age range and needs of residents living there. There are fifteen single rooms and three double rooms and at present ten bedrooms have ensuite facilities. The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection and took place over a period of six and a half hours. The Inspector spoke to four staff members, five residents, two relatives and the homeowner. A number of comment cards were issued at the start of the inspection. Five residents and two relatives returned these completed and all contained positive comments regarding the standard of the service provided at The Chimes. The inspection focused on assessing the standards that were not assessed at the previous inspection. This involved looking at the medication procedures, the quality of meals, social activities and the homes health and safety policies and procedures. What the service does well: What has improved since the last inspection?
The main lounge has been redecorated and furnished and now provides a pleasant and comfortable environment for residents. Training in the administration of medication is ongoing and it is the intention of the homeowner that all staff will be trained in this area.
The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standard 3 was assessed at the previous inspection. The Chimes Care Home does not provide intermediate care. The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The medication procedures ensure that residents receive medication as prescribed. All medication is stored and recorded appropriately. EVIDENCE: The administration of medication was, observed by the inspector this was carried out at the lunchtime meal. Medication was administered directly from the pharmacists packaging and the staff member observed the medication being taken. Records were seen to be clearly written and medication was signed for at the time of administration. Controlled drugs were stored separately and signed for by two staff members, however on checking the medication against the record it was evident that the stock did not correspond with the record, in that there was one tablet two many. The inspector advised that the additional tablet be retuned to the pharmacy and the record amended and signed. All prescriptions are now viewed prior to being dispensed and all medication in the main is recorded as it arrives in the home. It was noted that this system is
The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 10 not consistent as there was a few omissions in the amount of tablets received. The senior staff member explained that a checking system is in place and that one member of staff checks that the medication received is correct and then another member of staff double checks the record is correct. The inspector advised that greater attention is given to completing the record to ensure that an audit trail of all medication can be conducted. The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Social activities and meals are well managed to suit both the individual and group. Contact between residents and their families’ is encouraged to help maintain relationships. EVIDENCE: From observation and discussion with the cook evidence was found to confirm that the meals served were nutritionally balanced with a varied menu provided. The inspector noted good food stocks with plenty of fresh produce. Meals were unhurried and staff was observed assisting residents with eating and It was pleasing to note this task was carried out in an unhurried and respectful way. The meals were well presented and looked appetising however meals for residents requiring a soft diet should have their meals blended in a way that the food retains it colour and texture. All residents spoken with said that they enjoyed their meals and that a choice was always available. A range of activities are arranged which include trips out to local shows and attractions, in addition staff will escort residents on a one to one basis if they want to attend a family event or go shopping.
The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 12 There are no restrictions on residents and they are free to come and go as they please. The residents confirmed that they are able to exercise choice and control over their lives. One resident informed the inspector that she enjoys her own company and that no pressure is applied for her to join in communal activities. Visitors are welcome at any time and residents can entertain their guests in the privacy of their own room. Visitors spoken to at the time of the inspection confirmed that they are always made to feel welcome and are always offered refreshments. One visitor who visits every day said “whenever you visit nothing is ever any different the home is always welcoming and the staff are very friendly”. The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents are protected by a robust policies and procedures that enable concerns to be raised and responded to and to protect residents from abuse. EVIDENCE: The home has a comprehensive complaints procedure, which is contained in the Service User Guide and provided to residents and their relatives upon admission. The home has received no complaints since the last inspection. The Commission for Social Care Inspection has received no complaints within the last year and there have been no vulnerable adult referrals to Social Services. Whilst there have been no recent complaints the inspector did offer some advise on how to record any future complaints that may be raised. This involves developing a form that will record the actual complaint/concern/incident together with the investigation and the outcome. Comment cards received from residents and relatives completed at the time of the inspection confirmed that people were well informed in respect of the homes complaint procedure. Residents and relatives informed the inspector that should they have any concerns they would speak to the homeowner and have confidence that appropriate action would be taken. All the residents spoken to were happy with their care and had no concerns, one resident said that Margaret (home owner) “is marvellous she will do anything for you and she makes sure I don’t have any worries”. The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 14 The home has an abuse policy in place, which includes guidance on whistle blowing, abuse by residents and advice for staff regarding challenging behaviour. This policy is easily accessible by staff and is compliant with the D.O.H. guidance ‘No Secrets’. The training matrix maintained provided evidence that all have staff received training in the protection of Vulnerable Adults. The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Whilst the above the standards were not fully assessed at this inspection observations revealed that a hand washing facility is required to be fitted in the laundry room. This has been discussed at previous inspections and in order to minimise the risk of cross infection must now be given priority. The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of the above standards were assessed at this inspection. The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 and 38 The management and staff at the home are competent. The health, safety and welfare of residents is strongly promoted. EVIDENCE: Health and safety policies are in place and all staff receives training in all mandatory subjects, which include health and safety, first aid, infection control, fire safety and food hygiene. The fire alarm system is checked weekly and the last fire training was conducted in September 2005. Environmental risk assessments are in place however evidence was not available to confirm that all potential hazards had appropriate risk assessments. The inspector discussed the need to have comprehensive risk assessments in place that have been read and understood by staff and are available as a point of reference.
The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 18 From information supplied on the pre inspection questionnaire it is confirmed that all equipment is serviced at regular intervals. To reduce the risk of scalding all hot water outlets used by residents are fitted with fail-safe devices, in addition water is tested twice a year by an external company for Legionella decease. The homeowner is aware of the Control of Substances Hazardous to Health regulations, and all such substances are stored in the cellar. To homeowner was asked to remind the domestic staff to ensure that substances in use are not left unattended. The home is maintained to a satisfactory standard and no apparent hazards were apparent at the time of the inspection. The homeowner has plans to continue with the redecoration programme in order to maintain and improve standards. Resident’s finances are protected and the homeowner encourages all residents to retain responsibility for their own finances if they are able to do so. For those residents unable to manage their own affairs, relatives or a solicitor will be asked to take charge of any personal affairs. This strategy has resulted in the home assisting only one resident in managing her personal money. A record of all expenditure is maintained, however the record is somewhat sketchy and does not show the balance held. The inspector advised on the correct method of recording that will provide a more professional record and clearly show what money has been received, the expenditure and the balance held. The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP26 OP38 Regulation 23 23 Requirement Timescale for action 30/11/05 A hand wash basin must be fitted in the laundry room Risk assessments must be in 30/11/05 place for all environmental issues that carry a potential risk. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP15 OP16 Good Practice Recommendations A record of all medication received into the home should be maintained All food should be blended in a way that the food retains it colour and texture. A form should be developed that will record all complaints, concerns and incidents which will show the content of the complaint together with the investigation and the outcome. A more consistent approach should be adopted to the recording of resident’s personal finances. All substances in use that are considered hazardous to health should not be left unattended. 4 5 OP35 OP38 The Chimes DS0000009855.V260264.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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