Care Home: Chadwell House

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What the care home does well The statement of purpose and service user guide have been reviewed and updated, and are reflective of the service being offered at the home. We found that the home was very clean and that there were no offensive odours. Meals were well presented and a choice was offered to residents and it was apparent that dietary and cultural needs are being recognised and met. Dining tables in all of the units are laid so that they look welcoming and now make dining a positive experience for all of the residents. We were able to talk to the cook who demonstrated an awareness of the special health related dietary needs of residents, as well as those necessary for cultural or religious needs.Comprehensive pre-admission assessments for prospective permanent and respite continue to be undertaken by people who are qualified to do so. We were told by a relative "I visited the home before my dad was admitted and so was happy for him to live here." Medication administration is undertaken by staff who have been trained and the medication administration records (MAR) were being maintained as required by regulations. The activity co-ordinator works hard at ensuring that there are large and small group activities organised for the residents, and where necessary one to one sessions take place with some residents. We found that the administration of the home is of a very high standard with the administrator being very knowledgeable about all aspects of the operation of the service, and being a very valued member of the team. We were also told by residents and relatives that the administrator is excellent and one resident told us "I always go to B as he really listens and understands me and I think he is lovely." What has improved since the last inspection? We found that the management of the home has greatly improved and this has become more noticeable since the unannounced random inspection which took place in March, 2008. We were very pleased to note that the acting manager has made great strides in ensuring that the staff members now work as a whole team, and that their training is being implemented. This has meant that residents now receive effective personal and healthcare support using a person centred approach. Staff ensure that residents` rights of dignity, equality, independence and respect are being maintained at all times. A relative commented "the acting manager has made real improvements at this home, she is very approachable and has the interests of the people here at heart." A comment made by a member of staff was "I love working here. I have learnt a lot of things from C especially to treat all respectfully." A further comment from a member of staff was "Rotas are being correctly managed at long last. Also the manager does listen to care staff if we need more on duty. Nights have improved . We have support from C who understands about care and how it changes from day to day. I feel valued at long last." During the visit we were able to observe really good interactions between staff and residents on all of the units. As a consequence it was noticeable that residents were much more alert and able to hold some conversations with staff, each other and the inspectors. Care staff were engaged in undertaking activities with residents, and these included such things as sitting and chatting, reading a newspaper or magazine with a resident, playing games with a small group of residents or assisting residents to lay the dining tables. The needs of residents from ethnic minorities were now being met, and this was very noticeable especially around personal care, dietary needs and religious needs. The assessments for people undertaking respite care at the home have improved, and so has the information given to staff. This has meant that generally the service for people on respite has improved, and is more enabling for them to return home. We were pleased to find that the number of accidents/falls sustained by residents has greatly decreased since the random inspection undertaken in December, 2007, and safeguarding issues are now being properly dealt with. Currently there are no outstanding safeguarding issues at this home. There has been an extensive redecoration programme throughout the home, and this has included the laying of new carpets in the lounge areas and the laying of non-slip wood effect flooring in the corridors and dining rooms. New furniture is in place on many of the units, and on order for the other units. On the day of our visit we saw new garden furniture being delivered and this included bird tables, numerous tables and chairs/benches for the residents and sun shades. We were pleased to note that tables and benches had rounded ends to reduce the risk of residents hurting themselves on sharp corners. CARE HOMES FOR OLDER PEOPLE Chadwell House 372 Chadwell Heath Lane Chadwell Heath Romford Essex RM6 4YG Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 22nd May 2008 08:45a 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 Chadwell House DS0000067411.V364195.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. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chadwell House Address 372 Chadwell Heath Lane Chadwell Heath Romford Essex RM6 4YG 020 8983 8529 020 8599 3224 chris.gammons@sanctuary-housing.co.uk www.sanctuary-care.co.uk Sanctuary Care Ltd 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) Miss Sueann Barbara Balcombe Care Home 60 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (60) of places Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE (of the following age range: 55 years and over) The maximum number of service users who can be accommodated is: 60 31st July 2007 Date of last inspection Brief Description of the Service: Chadwell is a 60 bedded home for older people. This includes 50 beds for people with dementia and 10 beds for frail older people. The home is situated in the London Borough of Redbridge and is near to King George Hospital and close to public transport. There are 60 single rooms all with en suite. The home is accessible to wheelchair users. There is an enclosed rear garden that is well maintained. The home has two floors and is divided into six 10 bedded units. Each unit has a kitchenette, dining area, lounge and a communal bathroom and toilet. There is also an activities room located on the first floor. The current statement of purpose and service user guide is available in the home, and a copy can be obtained from the manager. At the time of this inspection the fees ranged from £523.98 to £600 per week and there are additional charges for services such as hairdressing, private chiropody, some outings and newspapers. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This was an unannounced key inspection undertaken by the lead inspector Mrs. Sandra Parnell-Hopkinson together with a colleague Mrs. Gwen Lording. It took place on the 22nd May 2008 and commenced at 08.45 hours over a period of 6.5 hours. The manager was available throughout the inspection, and was available for feedback at the conclusion of the visit. The inspection process included information contained in two previous random inspections, the annual quality assurance assessment (AQAA), previous regulation 37 notifications and regulation 26 reports, a tour of the home, questionnaires returned from residents, relatives and staff. We were also able to communicate with some of the residents and were able to talk to staff members and some relatives during the visit. We also contacted several health/social care professionals. We case tracked 18 people who use the service, together with viewing staff recruitment files, staff rotas, training schedules, activity programmes, maintenance records, accident records and menus. We have been told previously by the manager that the people using this service would prefer to be called ‘residents’ and, therefore, this term is used in this report. What the service does well: The statement of purpose and service user guide have been reviewed and updated, and are reflective of the service being offered at the home. We found that the home was very clean and that there were no offensive odours. Meals were well presented and a choice was offered to residents and it was apparent that dietary and cultural needs are being recognised and met. Dining tables in all of the units are laid so that they look welcoming and now make dining a positive experience for all of the residents. We were able to talk to the cook who demonstrated an awareness of the special health related dietary needs of residents, as well as those necessary for cultural or religious needs. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 6 Comprehensive pre-admission assessments for prospective permanent and respite continue to be undertaken by people who are qualified to do so. We were told by a relative “I visited the home before my dad was admitted and so was happy for him to live here.” Medication administration is undertaken by staff who have been trained and the medication administration records (MAR) were being maintained as required by regulations. The activity co-ordinator works hard at ensuring that there are large and small group activities organised for the residents, and where necessary one to one sessions take place with some residents. We found that the administration of the home is of a very high standard with the administrator being very knowledgeable about all aspects of the operation of the service, and being a very valued member of the team. We were also told by residents and relatives that the administrator is excellent and one resident told us “I always go to B as he really listens and understands me and I think he is lovely.” What has improved since the last inspection? We found that the management of the home has greatly improved and this has become more noticeable since the unannounced random inspection which took place in March, 2008. We were very pleased to note that the acting manager has made great strides in ensuring that the staff members now work as a whole team, and that their training is being implemented. This has meant that residents now receive effective personal and healthcare support using a person centred approach. Staff ensure that residents’ rights of dignity, equality, independence and respect are being maintained at all times. A relative commented “the acting manager has made real improvements at this home, she is very approachable and has the interests of the people here at heart.” A comment made by a member of staff was “I love working here. I have learnt a lot of things from C especially to treat all respectfully.” A further comment from a member of staff was “Rotas are being correctly managed at long last. Also the manager does listen to care staff if we need more on duty. Nights have improved . We have support from C who understands about care and how it changes from day to day. I feel valued at long last.” During the visit we were able to observe really good interactions between staff and residents on all of the units. As a consequence it was noticeable that residents were much more alert and able to hold some conversations with staff, each other and the inspectors. Care staff were engaged in undertaking activities with residents, and these included such things as sitting and chatting, reading a newspaper or magazine with a resident, playing games with a small group of residents or assisting residents to lay the dining tables. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 7 The needs of residents from ethnic minorities were now being met, and this was very noticeable especially around personal care, dietary needs and religious needs. The assessments for people undertaking respite care at the home have improved, and so has the information given to staff. This has meant that generally the service for people on respite has improved, and is more enabling for them to return home. We were pleased to find that the number of accidents/falls sustained by residents has greatly decreased since the random inspection undertaken in December, 2007, and safeguarding issues are now being properly dealt with. Currently there are no outstanding safeguarding issues at this home. There has been an extensive redecoration programme throughout the home, and this has included the laying of new carpets in the lounge areas and the laying of non-slip wood effect flooring in the corridors and dining rooms. New furniture is in place on many of the units, and on order for the other units. On the day of our visit we saw new garden furniture being delivered and this included bird tables, numerous tables and chairs/benches for the residents and sun shades. We were pleased to note that tables and benches had rounded ends to reduce the risk of residents hurting themselves on sharp corners. What they could do better: The registered manager for this home is currently on suspension pending a disciplinary by the organisation. This process has been very lengthy and it is recommended that this situation be resolved quickly for the future progress of the care home and of the residents. Currently the home is still using two different sets of documentation around care plans. Often both the old and the new documentations are being used, and this is very confusing for anybody wanting to track details and evidence. The new care plan documentation is based on clinical models and is very difficult for non- nursing staff to understand and implement, and also it is not very person centred. It is essential that the organisation resolves the difficulties around the new care plan documentation so that staff have the confidence to implement this, and that residents and relatives can be involved in the care planning in a more constructive way. We were satisfied that care was not compromised by the shortcomings of the care planning documentation, but this was because staff were able to demonstrate knowledge of the individual person’s needs. We did note that some staff are recording in metric weight and others in imperial weight. It is strongly recommended that there is a consistent use of one weight measurement. This will avoid confusion for staff and other professionals. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 8 Where hand written entries are made on the medicine administration records (MAR) these should be signed by two members of staff, and also where medication is either 1 or 2 tablets then the actual dose administered should be recorded. 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. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 9 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 Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3 and 5 (standard 6 does not apply to this service) People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. The statement of purpose and service user guide have been updated and this means that people moving into the home are given correct information to enable them to make an informed decision on where to live. A full assessment of needs is undertaken for each prospective resident, so that he/she can be sure that they will get the right care for them. They are also encouraged to visit the home to meet other residents and staff before making a decision to move in. EVIDENCE: We found that the statement of purpose and the service user guide have been reviewed and updated. It was evident from viewing files that permanent residents had a comprehensive assessment of need undertaken prior to them moving into the Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 11 home. The information had been used to continue assessment following admission to the home, and to develop written care plans. The records showed that residents where possible, and their relatives are involved in the assessment process. Where appropriate, information provided by the placing authority was also on file. We also found that residents had a contract or a statement of terms and conditions, and that these had been signed by either the resident or a family member. A comment received from a relative on a returned questionnaire was “I received a contract on the first day.” We were also pleased to note that the assessment process for people needing respite care has improved, and that staff were far more informed around the needs of these residents. A relative told us that she had visited 3 homes, including Chadwell House, prior to her father moving in, and that she felt that this helped her to make the decision that Chadwell House would be right for her father. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 12 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 and 11 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. The health and personal care needs of residents are being met in ways that are reflective of the ethnic, religious and cultural needs of the residents. The medication policies and procedures ensure that residents are protected in the administration of medication by staff who have been trained. Residents can be sure that they will be treated with respect and that their right to privacy is upheld, and also that at the time of their death, staff will treat them and their family with care, sensitivity and respect. EVIDENCE: We case tracked 18 people, 3 on each of the 6 units, during this visit and found that all had a comprehensive pre-admission assessment and that all had a care plan. New care planning documentation has been introduced and this was in various stages of implementation across the service. This is currently being used in tangent with the previous care planning documentation. We were told by the manager that the organisation’s intentions are that this new model of care planning documentation will provide staff with an effective Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 13 working tool. However, it includes many comprehensive assessment tools which have a clinical base, and even experienced care staff require extensive training in the use of the new care plan model. Staff will also need an understanding of how to use the assessment information. In discussions with both senior and care staff it was apparent that they found the new format confusing, and at times it called for very subjective recordings to be made. It would also be difficult for residents and their families to be actively involved in the development of a meaningful care plan due to the number and complexity of tools being used. The intention is for staff at all levels to receive training in the use of this tool but it may have been prudent and beneficial to staff if they had received this training prior to the introduction of the new documentation. We found it difficult in some cases to case track written information, but all staff were able to give good verbal accounts of residents’ needs and we were able to evidence that residents care needs were being understood and met on a daily basis. A good source of written information was the monthly reviews, which are completed by the individual’s key worker. These were very informative and sufficiently detailed as to be understood by all staff and to others who may not be as familiar with the individual resident. However, it was evident that this information had generally been sourced from the old type care plans and not from the new documentation. Care plans should also be more informative about night care needs and also end of life wishes. This was discussed with the manager during the visit. Care plans did show that residents are able to access GP, dental care, chiropody services, optical and other specialist services as necessary. There is close liaison with the local Community Mental Health Team and the Dementia Resource Centre, which is to be benefit of residents and sources of advice for staff. Where a resident has a hearing aid, we noted that a record is being maintained of battery changes. A resident who had a diagnosis of Parkinson’s Disease has made great improvements due to the involvement of the specialist Parkinson’s nurse and through staff training in recognising symptoms. Nutritional screening is being undertaken on admission and a record of nutrition maintained. Weights are monitored monthly, or more frequently where indicated and a record is maintained, including weight gain or loss. Where there are concerns appropriate action is taken, with a referral being made to a dietician or nutritional service. We did note that some staff are recording in metric weight and others in imperial weight. It is strongly recommended that there is a consistent use of one weight measurement. This will avoid confusion for staff and other professionals. Equality and diversity issues are identified and addressed by the staff, and there was evidence of this seen in individual care plans. For example, specific cultural needs identified around skin/ hair care and food; and religious needs and preferences. However, although staff were well informed as to the Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 14 individual preferences of residents around gender care, this was not generally documented on the care plans. Accidents sustained by residents are being recorded on their individual files, with risk assessments being updated when necessary. There is also a 24-hour observation record to follow up all accidents. The manager completes a monthly accident incident summary to monitor and audit trends of accidents within the home. We were pleased to note that the number of accidents/incidents within the home have greatly reduced. We also evidenced referral to the specialist falls clinic for individual residents, and there is also use of assistive technology to aid the reduction of falls where a risk assessment indicates that this would be of use. An audit was undertaken for the handling and recording of medicines within the home, and we examined a random sample of Medication Administration record (MAR) charts on each unit. Discussions with staff and the review of medication records and systems show that staff are following policies and procedures, so as to ensure that residents are safeguarded with regard to medication. Each unit has a ‘Medication Resource’ folder, which includes all current medication, its active constituents, side effects etc. The service has recently changed the supplier of the monitored dosage system used by the home. Staff reported some initial ‘teething’ problems but the manager has addressed these directly with the suppliers. Where residents have difficulties in swallowing, the manager discusses this with the GP so that alternatives such as liquid medication can be prescribed. We also noticed that where staff are writing entries onto the MAR charts these are not being countersigned by another member of staff, and also where medication shows as 1 or 2 tablets then the number administered at any time is not being recorded. These issues were discussed with team leaders and the manager during the visit, and undertakings have been given to amend the procedures. Staff at the home have been involved in training in palliative care and the Liverpool Care Pathway, and some staff are now involved with training in dementia care and end of life which will be a recognised certificated qualification. All residents can be sure that at the end of their life they will be treated with care and respect, and that their families will be supported at such a difficult time. If they choose to remain at the home, this would be facilitated by the manager who would ensure that such a wish could be complied with, and this would mean the involvement of the resident, their family, GP, district nurses or other specialist nurses and other professionals where appropriate. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 15 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 and 15 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents find the lifestyle experienced in the home matches their expectations and preferences, and that it matches their social, cultural, religious and recreational interests and needs. Residents are encouraged to maintain contact with family/friends and some with the local community. They are helped to exercise choice and control over their lives and also receive a wholesome, appealing balanced diet. People living at the home can be sure that they will benefit from living there and that their quality of life will improve. EVIDENCE: During a tour of the home we found that the daily living routines were very flexible. Residents can choose when to get up in the mornings and when to go to bed in the evenings, or even have a rest during the day. The home has a full time activity co-ordinator and she is viewed as a valued member of the staff team. There is a planned general programme of activities for all residents and the activity co-ordinator has given a great deal of consideration and time in planning and undertaking activities both inside and Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 16 outside of the home, in consultation with residents and relatives. All residents have a completed activity assessment and individual activity record. This provides information on preferences/interests and guidance on the appropriate level of activity for the individual. Residents are able to receive visitors at any reasonable time and all residents are encouraged to maintain links with the local community. Within the home residents are encouraged to form mutually consenting friendships, and where necessary and appropriate discussions are held with family members. Trips are organised into the community for leisure and shopping. Arrangements have been made for a resident to visit his family for the day on a regular basis, and this has really helped to assist this person in settling down at the home. A minibus is usually available on a Monday and this opportunity is used by the activities co-ordinator to take residents to various venues within the community. From talking to residents, relatives and staff and from observations on the day, we were able to evidence that the routines of daily living and activities are flexible and varied to suit the preferences and capabilities of the residents. Activities include large group, small group and individual activities with residents. The activity co-ordinator has been able to arrange more outdoor activities because the manager has ensured that the ratio of staff to residents is now sufficient to provide the increased level of support required whilst undertaking such trips away from the home. We were told that there had been a trip to Southend the previous day for a number of residents. For one resident this has proved particularly enjoyable as members of his family are visiting from abroad and staff successfully co-ordinated meeting up with them in Southend. The resident was able to have lunch with his family, supported by staff. The resident told us: “It was a great day. We had a fish and chip lunch and went to the Sea Life Centre. I was able to see my family who are here on holiday”. A weekly list of activities is produced and displayed prominently throughout the home. A monthly newsletter is also produced and widely circulated. A number of events are planned for the next few months, and these include a garden party with strawberry cream tea and professional entertainment; summer barbeque and a visit to London Zoo. Plans are also being made for a multi cultural event where all cultures will be celebrated and recognised through food, clothes and music. Religious services are held at the home, and again these are now more reflective of the needs of the residents. For example people come from a local Pentecostal church and during the inspection were seen to be in discussions with the activities co-ordinator around a selection of hymns. In all of the lounges we found that there were daily newspapers and magazines which many of the residents were interacting with, either with or without the assistance of staff. On all of the units staff were seen to be engaged with residents, either sitting and chatting, playing games or reading with them. The majority of the residents appeared to be very alert and there was a lot of Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 17 laughter and banter between them and staff. Several residents were seen to be laying dining tables for lunch, and one or two were folding napkins. We observed members of staff allowing time for residents to express their wishes and supporting individuals to make choices in their daily lives. All staff are made aware that Chadwell House is the home of the residents and both individually and as a team, staff try very hard to make the care home a pleasant place to live. Visiting times are flexible and relatives/friends are encouraged to visit. Residents spoken to said that they always felt very welcomed by staff. Residents and relatives meetings are now being held and these have helped to improve communication between staff and family members. One relative commented: “Communication has improved recently and we are now more clearer about who to talk to if we have a concern”. We attended a relatives meeting which was also very helpful and informative. The health and well being of (X) is much improved”. Another comment made by a relative on a returned questionnaire was “it has improved a lot in the last months because the new manager is good – always on hand.” We were able to observe breakfast on all of the units, and the lunchtime meal being served on units on the ground and first floor. Staff were seen to offer assistance and encouragement where necessary, and this was done discreetly and individually. An isolated incident was observed where a member of care staff did not offer a resident the correct level of assistance with their meal. We were pleased to observe that this was immediately addressed by a team leader who was also present in the dining room and had observed the poor interaction. On all units dining tables were routinely laid with tablecloths, napkins, cutlery, glasses and condiments. The settings were very congenial and there was a nice relaxed atmosphere throughout the meals on all of the units. Pictorial menus have been developed which are used to encourage and assist residents in making a choice at meal times. Menus are now reflective of the different cultural and religious needs of residents, and care staff were now able to demonstrate an awareness of the different dietary needs of people. A visit was made to the main kitchen and we were able to discuss the storage and preparation of food and menus with the cook. She demonstrated a good knowledge and understanding of the importance of well balanced and well presented meals, and the special dietary needs of some residents. There is little reliance on processed or frozen foods, and fresh fruit is available on all of the units. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 18 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 and 18 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents and their relatives and friends can be confident that their complaints will be listened to, taken seriously and acted upon by the manager. Residents are also protected from abuse through improved communication, staff training and the home’s policy and procedures. EVIDENCE: We saw that the home has a written complaints policy and procedure and that a complaints log is kept of complaints received and it included details of the investigation, action taken and the outcome for the complainant. Complaints and concerns made to the manager are always taken seriously and she actively addresses all concerns and aims to resolve issues to the satisfaction of the complainant. Staff are now more aware of how to deal with a concern before it becomes a complaint, and this has improved the service to residents and relatives. All staff have undertaken training in safeguarding adults and recognising and reporting abuse. We were able to speak to both team leaders and care staff and all were able to demonstrate a good understanding of what constitutes abuse, and were aware of what action to take if they had concerns about the safety and welfare of residents. Staff were also aware of the organisation’s whistle blowing policy. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 19 At the date of this inspection there are no outstanding safeguarding issues, and we were pleased to note the improvements made in this area such as training, improved communication and the review of staffing resources and redeployment. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 20 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, 24, 25 and 26 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents live in a safe, clean and hygienic environment, which is nicely decorated and furnished. Signage and décor throughout the home is now more reflective of the needs of people living with dementia, and is assisting them with finding their way around the home. EVIDENCE: We toured the premises, accompanied by the manager, at the start of the visit and all areas were visited again during the day. We were very pleased to note the vast improvement which has been made to the environment since the last key inspection in July 2007. Some bedrooms were seen either by invitation of the resident, or because the doors were open or being cleaned. All of the bedrooms seen were very Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 21 personalised and reflective of the occupant’s culture, religious and personal interests, and many have been redecorated. All of the lounges had been laid with new carpet, and the corridors and dining rooms had been laid with non-slip wood flooring. Most of the home has now been redecorated, and new furniture is either in place or on order. Pictures which would have meaning to the residents were displaying in many of the units, and residents were seen to be looking at these during our visit. Odour control and cleanliness throughout the home was to a good standard. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. On the day of the visit new garden furniture was being delivered and erected in many of the garden areas. We saw several residents being taken out to the gardens by staff so that they could see the new furniture and “try it out”. All agreed that it was very attractive and residents were looking forward to spending more time in the garden during the forthcoming summer. Bird tables had been included in the new furniture, and a resident told us “I am looking forward to putting out food for the birds, and I will be able to see them from the lounge.” We visited the laundry area and this was found to be clean, with soiled articles, clothing and infected linen being appropriately stored. Laundry staff were aware of health and safety regulations with regard to handling and storage of chemicals. Personal Protective Equipment (PPE) such as clothing, gloves, masks and goggles were available. There is a room on the ground floor which has been set aside for those residents who smoke, and this does comply with the new regulations. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 22 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 and 30 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. People using this service can be sure that their needs will be met by the numbers and skill mix of staff, and that they are in safe hands. Residents are supported and protected by the home’s recruitment policy and practices and staff are receiving training to ensure that they are competent to do their jobs. EVIDENCE: We were pleased to note from staff rotas and from talking to staff and relatives that all of the units were now being covered by two members of staff at all times. There is a duty officer who now covers a unit if a member of staff is having a break, and the acting manager has ensured that at all times sufficient staff are on duty to meet the needs of the residents. This has ensured that the service has improved, and it was also apparent that staff were happier and more motivated. Comments made by staff include “manager always talks with us, backs us up and helps when needed”; “very constructive induction training” and “I am enjoying my role at Chadwell House, very well respected and valued which is important as a staff team.” Staff training is given a high profile and the majority of staff members have undertaken training in the implications of the Mental Capacity Act 2005. Currently 97 of staff have achieved NVQ level 2, or 3 and some team leaders are completing NVQ level 4, and 1 will be commencing the Registered Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 23 Managers Award. Training has also been undertaken in safeguarding, moving and handling, dementia awareness, palliative care, health and safety, infection control, promoting continence and oral hygiene. We inspected the files of 3 new members of staff and found that the necessary references, criminal records bureau disclosure, POVA first (if necessary), job description, contract and evidence of identity were in place. Interviews for care staff and other staff involve the manager. It is essential that the manager is involved in all new appointments at the home, to ensure that the skills and qualifications are appropriate to the needs of the residents, and also that any shortfalls are identified so that the necessary support and training can be given at the earliest opportunity. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35, 36 and 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home which is currently managed by an acting manager on a day to day basis by a person who is fit to be in charge and able to discharge her responsibilities to the benefit of residents and staff. Residents can feel sure that their financial interests are safeguarded, that staff are appropriately supervised and that the health, safety and welfare of residents and staff will be promoted. EVIDENCE: We found that the acting manager, who is also the registered manager of another home operated by the organisation, is very resident focused and has worked extremely hard in the past 6 months during the absence of the actual Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 25 registered manager for Chadwell House. Her hard work has meant that the service to residents has greatly improved and has added to their quality of life. She is building a strong, effective and supportive staff team and working in partnership with the families of residents and professionals. Under her leadership there have been marked improvements in the service delivery and quality of care in the home, across all areas of the service. Comments from staff support this improvement and include statements such as “Staff are respected and feel valued” “We are now a team of staff working together for the benefit of the residents”. Another comment was “it is great when she is here but she also has to look after another home. She is so different, strict but very kind and explains all we need to know.” The acting manager was able to describe a clear vision of the home and communicates a clear sense of direction and was able to evidence a sound understanding and application of best practice in relation to continuous improvement. Equality and diversity and person centred thinking are given priority by the acting manager and this was demonstrated during our visit. We found that at all times the acting manager provides an excellent role model for other employees. It was evident from discussions with other professionals that they also see the acting manager as an imaginative and effective leader who consistently provides high quality services. Staff members told us that they receive regular supervision and this was confirmed in viewing documentation and in discussions with the manager. Supervision is generally 1:1 but also includes group supervisions and observations of care practice while working with residents. The organisation regularly reviews the policies and procedures, and quality monitoring visits are undertaken on a monthly basis with reports being sent to the Commission as well as to the manager of the home. Notifications of incidents of significant events which affect residents are sent to the Commission as necessary. We were very pleased to note that such notifications have greatly reduced during the past few months. Currently the manager does not act as an appointed agent for any residents. Residents’ financial affairs are managed by the individual resident, or their relatives/ representatives. There is a financial system in place, which is managed by the home’s administrator. Through discussion with the administrator and records inspected, there was evidence to show that the residents financial interests are safeguarded. Secure facilities are provided for the safekeeping of any monies or valuables held on behalf of residents. We examined a random sample of maintenance records including fire safety; lift and hoist maintenance; emergency lighting; health and safety checks and gas/ electrical safety. These were found to be in good order, up to date and well maintained. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 26 There is a corporate business plan which details the business arrangements for monitoring the performance and practice of the home, and the home also has its own business plan for 2008/2009. Because the improvements identified in this report are directly attributable to the work undertaken by the acting manager. There is not the evidence that this will be sustained in the longer term because of the current uncertainty around the future longer term management of the home. The overall outcome is therefore being judged as good to recognise the improvements made but also to reflect the current uncertainty. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 27 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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 4 3 X 3 Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered person must ensure that the service user’s plan (care plan) is comprehensive and has included the service user in the development of the plan. It must also be available to the service user in a format which can be understood by him/her or family members where appropriate. This is so that the individual is made aware of the care to be delivered and how the delivery of this care will be effected. Timescale for action 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations It is recommended that weights are recorded in a consistent use of weight measurement, either metric or imperial. This will avoid confusion for staff and other DS0000067411.V364195.R01.S.doc Version 5.2 Page 29 Chadwell House 2 OP9 professionals. It is recommended that where hand written entries are made on the medicine administration records (MAR), these should be signed by two member of staff so that the entry is verified. Also where medication is either 1 or 2 tablets then the actual dose administered is recorded so that an accurate record of medicine administered is maintained. Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Chadwell House DS0000067411.V364195.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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