Care Home: Chaldon Rise

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What the care home does well Residents live in a clean and homely environment. Residents receive an excellent standard of health care support with prompt medical intervention and advice being sought, with several examples noted whereby since being admitted to the home a residents physical health has improved significantly. Personal support is offered in ways, which promotes and protect resident’s privacy and dignity with a resident saying that staff always knock on the door.Chaldon RiseDS0000013307.V378286.R01.S.docVersion 5.2Residents who have dementia benefit from a good standard of specialist care and support. A sample of comments made about peoples experiences included: “Look after me all the time there is always someone around to help me” “I am more than happy they are doing their best in an often impossible situation” ”the care given is second to none” and “it’s a very friendly home and homely atmosphere” “my experience of the home was very good” and “quite a nice home my dad really liked it and in fact wants to go back for further stays”. The meals offered choice and variety and catered for special dietary needs. Residents comments about the foot included: “food very good” and “lovely” Links with families and friends are valued and supported by the home. Residents are generally able to exercise some choices over their daily lives with a resident confirming that they are “free to get up and go to bed when I want”. Residents and the majority of relatives consulted feel that their views would be listened to if they had any concerns, with a relative commenting “they listen to concerns and act on them” and “act promptly when a problem is noted”. Staff contribute positively to the quality of life of residents, through their personal qualities and having most of the training and skills they need to be able to work safely and effectively with most residents. Without exception all persons consulted spoke positively about the caring qualities of staff and a sample of their comments included: “staff all very nice and helpful” “the care given is second to none” “staff very good helpful and kind” “staff have a lot of patience” and “really nice staff you can have a laugh with some of them”. Resident’s benefit from an approachable manager who is an experienced nurse and who provides a good sense of direction and ethos to help promote good practices. Comments about the manager included “manager met a couple of times very pleasant knew what she was talking about” “very helpful” and “very supportive”. The home regularly reviews aspects of its performance through a good program of self-review and feedback. What has improved since the last inspection? There were no shortfalls in practices noted at the previous inspection which resulted in requirements being made. The creation of a wet room will enable, once completed, residents to be able to have an assisted shower. A sensory garden has been created which provides level access and raised beds. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.2 The home reported that there they have minimised hospital admissions through being able to carry out re-hydration programmes within the home. What the care home could do better: There is an extremely wide range of needs and ages being accommodated at the home with residents receiving variable experiences. There is a need to ensure that residents who have a learning disability or mental health needs that their social, environmental and developmental needs can be met. A staff member commented “It is quite challenging having many residents with such different needs not always sure we are doing the best that we could for some of our residents”. The environment needs to be able to meet the wide range of resident’s needs and ages. Consistent feedback was received regarding the small size of some bedrooms with a resident saying “you can’t swing a cat in here” and dated fixtures and fittings. Bedrooms need to reflect an individual’s age and needs. Where restrictions are placed on residents freedom of movement this must be based on the appropriate assessment of risk, capacity or deprivation of liberty. A residents said “it is run like a secure hospital and that it is embarrassing having to ask for doors to be unlocked”. The provider reported that they have been waiting to improve environmental standards at the home through an extension programme and are still awaiting planning permission. This will help improve the size of some bedrooms and create distinct areas/units to accommodate the different range of needs. This arrangement will then enable much more focused support on the specialist needs of residents and help to reduce some of the current frictions of such a wide group of residents needs living altogether. To promote an inclusive service for all residents many of the homes documentation, information provided about, complaints procedures, menus and feedback surveys need to also be provided in a format that is suitable for them. This with particular reference to the use of easy read formats, pictures or symbols. In order to promote individualised consistent support, care plans need to be person centred and include the range of individual needs and provide staff with the guidance they need to be able to meet residents needs. Further opportunities need to be provided for some residents who have a learning disability or mental health to access the community and undertake age appropriate activities to meet their social and developmental needs. To help ensure that residents and their representatives are aware of their rights and responsibilities while residing at the home, all residents need to be provided with a copy of the homes terms and conditions of residency which make clear any additional charges.Chaldon RiseDS0000013307.V378286.R01.S.doc Version 5.2 Information on the prospective needs of residents should always be accurately provided to staff to ensure they are aware of the individuals needs upon admission. To help reduce some of the conflicts of communal living for a wide range of residents the meal time arrangements should be reviewed to ensure that staff have sufficient opportunity to be able to provide consistent support and residents are able to eat their meals in an environment that suites their preferences and needs. To promote resident’s privacy all observational windows in ground floor bedrooms should be covered. The manager was aware of the need to provide specialist training in mental health and further training in learning disabilities and challenging behaviour in order to improve staffs understanding of the needs of residents. Key inspection report CARE HOMES FOR OLDER PEOPLE Chaldon Rise Rockshaw Road Merstham Surrey RH1 3DB Lead Inspector Jane Jewell Key Unannounced Inspection 10:30 5th November 2009 DS0000013307.V378286.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chaldon Rise Address Rockshaw Road Merstham Surrey RH1 3DB 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) 01737 645171 01737 644590 chaldon@careunlimited.co.uk Care Unlimited Mrs Carmelita Paat Shamtally Mrs Elaine Wantoch Care Home 34 Category(ies) of Dementia - over 65 years of age (34), Learning registration, with number disability (10), Mental disorder, excluding of places learning disability or dementia (5) Chaldon Rise DS0000013307.V378286.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 with Nursing (N) - to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Learning disability (LD) Mental disorder (MD) The maximum number of service users to be accommodated is 34 2. Date of last inspection 6th November 2007 Brief Description of the Service: Chaldon Rise is a large detached domestic period property which has been converted and extended over the years. The home is located in a semi-rural area on the outskirts of the village of Merstham in Surrey. The home is registered to provide nursing care up to thirty four people, some of whom have dementia, mental health conditions or learning disabilities. Short term care and long term placements are provided. The home is owned and operated by Care Unlimited who have further registered services in the south east. The organisations head offices are located in the grounds of the home. The premises are arranged across three floors with level access provided by a passenger lift. Communal space consists of a conservatory, quiet room, dining room and lounge. The home is set in its own grounds with garden areas, including a newly created sensory garden. The majority of resident’s bedrooms are for single occupancy and have toilet en suite facilities. The manager reported that the current range of fees are from £765.00 to £1,200.00 per week, depending on room, the services and facilities provided which are based on an individual’s level of need. Extra’s such as: newspapers, hairdressing, chiropody, transport, toiletries are additional costs. Refer to the homes literature for the actual amounts charged for any additional costs. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.2 Page 5 Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is Two star. This means the people who use the service experience Good quality outcomes. The information contained in this report has been comprised from an unannounced inspection undertaken over eight and half hours, from 10:30am to 7pm and information gathered about the home before and after the inspection. The manager had completed an Annual Quality Assurance Assessment (AQAA) within the date requested. This provided a good standard of information about the home which has been used to inform the inspection process. The inspection was facilitated by Elaine Wantoch (registered manager) and in part by the providers and quality assurance manager. The focus of the inspection was to look at the experiences of life at the home for people living there. The inspection consisted of being shown the communal areas, and being invited to view some resident’s bedrooms, examination of the homes documentation and observations of resident’s daily routines and in their interactions with staff, during lunch time and over the morning and afternoon period. Seven residents, seven staff and four relatives were consulted as part of the inspection process. Feedback surveys were sent to the home for distribution, in order to obtain the views on the quality of the services and facilities being provided. Eight were returned, six from residents who were supported to complete the form by their relative and two from staff. Their feedback is included in this report. There were twenty nine residents living at the home at the time of the inspection. The inspector would like to extend thanks to the residents staff and management at the home for their assistance and hospitality. What the service does well: Residents live in a clean and homely environment. Residents receive an excellent standard of health care support with prompt medical intervention and advice being sought, with several examples noted whereby since being admitted to the home a residents physical health has improved significantly. Personal support is offered in ways, which promotes and protect resident’s privacy and dignity with a resident saying that staff always knock on the door. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.2 Page 7 Residents who have dementia benefit from a good standard of specialist care and support. A sample of comments made about peoples experiences included: “Look after me all the time there is always someone around to help me” “I am more than happy they are doing their best in an often impossible situation” ”the care given is second to none” and “it’s a very friendly home and homely atmosphere” “my experience of the home was very good” and “quite a nice home my dad really liked it and in fact wants to go back for further stays”. The meals offered choice and variety and catered for special dietary needs. Residents comments about the foot included: “food very good” and “lovely” Links with families and friends are valued and supported by the home. Residents are generally able to exercise some choices over their daily lives with a resident confirming that they are “free to get up and go to bed when I want”. Residents and the majority of relatives consulted feel that their views would be listened to if they had any concerns, with a relative commenting “they listen to concerns and act on them” and “act promptly when a problem is noted”. Staff contribute positively to the quality of life of residents, through their personal qualities and having most of the training and skills they need to be able to work safely and effectively with most residents. Without exception all persons consulted spoke positively about the caring qualities of staff and a sample of their comments included: “staff all very nice and helpful” “the care given is second to none” “staff very good helpful and kind” “staff have a lot of patience” and “really nice staff you can have a laugh with some of them”. Resident’s benefit from an approachable manager who is an experienced nurse and who provides a good sense of direction and ethos to help promote good practices. Comments about the manager included “manager met a couple of times very pleasant knew what she was talking about” “very helpful” and “very supportive”. The home regularly reviews aspects of its performance through a good program of self-review and feedback. What has improved since the last inspection? There were no shortfalls in practices noted at the previous inspection which resulted in requirements being made. The creation of a wet room will enable, once completed, residents to be able to have an assisted shower. A sensory garden has been created which provides level access and raised beds. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.2 Page 8 The home reported that there they have minimised hospital admissions through being able to carry out re-hydration programmes within the home. What they could do better: There is an extremely wide range of needs and ages being accommodated at the home with residents receiving variable experiences. There is a need to ensure that residents who have a learning disability or mental health needs that their social, environmental and developmental needs can be met. A staff member commented “It is quite challenging having many residents with such different needs not always sure we are doing the best that we could for some of our residents”. The environment needs to be able to meet the wide range of resident’s needs and ages. Consistent feedback was received regarding the small size of some bedrooms with a resident saying “you can’t swing a cat in here” and dated fixtures and fittings. Bedrooms need to reflect an individual’s age and needs. Where restrictions are placed on residents freedom of movement this must be based on the appropriate assessment of risk, capacity or deprivation of liberty. A residents said “it is run like a secure hospital and that it is embarrassing having to ask for doors to be unlocked”. The provider reported that they have been waiting to improve environmental standards at the home through an extension programme and are still awaiting planning permission. This will help improve the size of some bedrooms and create distinct areas/units to accommodate the different range of needs. This arrangement will then enable much more focused support on the specialist needs of residents and help to reduce some of the current frictions of such a wide group of residents needs living altogether. To promote an inclusive service for all residents many of the homes documentation, information provided about, complaints procedures, menus and feedback surveys need to also be provided in a format that is suitable for them. This with particular reference to the use of easy read formats, pictures or symbols. In order to promote individualised consistent support, care plans need to be person centred and include the range of individual needs and provide staff with the guidance they need to be able to meet residents needs. Further opportunities need to be provided for some residents who have a learning disability or mental health to access the community and undertake age appropriate activities to meet their social and developmental needs. To help ensure that residents and their representatives are aware of their rights and responsibilities while residing at the home, all residents need to be provided with a copy of the homes terms and conditions of residency which make clear any additional charges. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.2 Page 9 Information on the prospective needs of residents should always be accurately provided to staff to ensure they are aware of the individuals needs upon admission. To help reduce some of the conflicts of communal living for a wide range of residents the meal time arrangements should be reviewed to ensure that staff have sufficient opportunity to be able to provide consistent support and residents are able to eat their meals in an environment that suites their preferences and needs. To promote resident’s privacy all observational windows in ground floor bedrooms should be covered. The manager was aware of the need to provide specialist training in mental health and further training in learning disabilities and challenging behaviour in order to improve staffs understanding of the needs of residents. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 10 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 Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 and 5 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of information about the home and what to expect when living there. However all residents need to be provided with copies of the homes terms and conditions and the information about the home needs in be provided in range of formats to suite the various needs being accommodated in order to help residents make informed choices. There is an assessment process in place to ensure that the needs of prospective residents are assessed prior to any admission, this information then needs to be accurately provided to staff for them to provide the support necessary to meet their needs. There is an extremely wide range of needs being accommodated at the home with residents receiving variable experiences, with the needs of residents who have dementia able to be met however not all residents needs who have mental health or learning disabilities are being addressed. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 12 EVIDENCE: The home’s statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, provides a range of information about the home. These are made available at the home and given to prospective residents, representatives and other interested parties. The manager has recently updated the statement of purpose in light of changes to the organisation. As there are a wide variation in needs the home is registered for it was discussed that information about the home should be in a format accessible to the range of needs being accommodated. This with particular reference to the use of easy read formats, pictures or symbols to enable the range of prospective residents to be informed about the home and what to expect, so help them make informed decisions. Residents who are funded by a placement authority are provided with a generic contract from that placement authority. Privately funded residents are provided with the homes terms and conditions which are specific to the home and notes their rights and responsibilities while residing there. A short term care resident did not have a contract provided. It is recommended that all residents are provided with copies of the homes terms and conditions to help make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. To promote good practices the home sought clarification in 2005 from trading standards to ensure that their contract met their criteria. Since 1st September 2006 amendments to the care homes regulations were made which increased the detail of information required in the homes terms and conditions. The finance director agreed to review the homes current terms and conditions to ensure that contracts now meet these criteria. One relative has raised issues about being unclear of the additional charges for continence aids with the Commission since the previous inspection. In order to ensure transparency for both residents and the home, as it was fedback that the home does not always charge the full amount for continence aids, further clarity is needed on the additional charges in the terms and conditions, which the finance director agreed to undertake. The homes admission procedure is that prospective residents are assessed by a manager or provider with information about their needs gathered from a variety of sources including the resident, their representative and health care professional. This also includes an assessment by any placement authority. In the majority of cases comprehensive information is gathered and provided to staff to help ensure that they are aware of the residents needs prior to their arrival, however one example was noted whereby important information on a needs assessment did not get transferred to the care plan in order to promote Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 13 the individuals independence or safety. The manager agreed to update the care plan immediately. There is an extremely wide range of needs currently being accommodated at the home. This includes residents who have a learning disability and who’s ages range from 30 to 80 years old, older people who have complex dementia needs including physical and challenging behaviour and residents who have a past or present mental health conditions, who’s age ranges start at 53 years. Most people consulted about the home spoke positively about their experiences for people who have dementia and a sample of their comments included “Look after me all the time there is always someone around to help me” “I am more than happy they are doing their best in an often impossible situation” ”the care given is second to none” “it’s a very friendly home and homely atmosphere” “my experience of the home was very good” and “quite a nice home my dad really liked it and in fact wants to go back for further stays”. Through discussion, observation and examination of the homes documents it was evident that the home is able to meet the needs of people who have dementia to a good standard. However what the home could not always evidence was being able to meet the needs of people with a learning disability and mental health needs. This is with particular reference to their social and development. Currently there are no distinct areas/units to accommodate the different range of needs which resulted in one resident speaking about how vulnerable and distressing they find the behaviour of some residents, which affects their quality of life. A staff member commented “It is quite challenging having many residents with such different needs not always sure we are doing the best that we could for some of our residents”. Residents and their relatives spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home as many times as they liked. The manager confirmed that the first six weeks of occupancy is looked upon as a trail period. Following this, placements that are funded by social services are reviewed, to establish whether the home is meeting a residents needs. A formal process is also in place for privately funded residents to have a say whether they wish to remain at the home and become a permanent resident. Intermediate care is not offered at the home therefore this standard is not assessed. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 and 10 People using 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 would benefit from a more individualised and comprehensive care planning system that would guide staff in all aspects of the support, developmental and care needs of residents in order to promote individualised consistent care. Residents receive an excellent standard of health care support with prompt medical intervention and advice being sought. Medication practices are generally well managed promoting good health. Personal support is offered in ways, which promotes and protect resident’s privacy and dignity, however some environmental elements do not always promote residents privacy. EVIDENCE: Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 15 Plans of care are available for each resident and seven were sampled. These contained variable standards of information about the needs of residents, largely generic based and in some cases did not reflect the support being undertaken by staff or include the range of residents needs. This is with particular reference to providing guidance on managing challenging behaviour, continence needs, use of body maps, social, developmental and communication needs and capacity assessments where individual’s freedoms are restricted. The manager reported that work has commenced to develop a person centred approach to care planning especially for those residents who have a learning disability. To ensure that staff have the guidance they need to be able to meet residents needs in an individual and consistent way it has been required that care plans are improved to include all of the individual needs of residents. The regular review of care plans helped to ensure that most changes in resident’s needs and preferences can be promptly identified. Annual placement reviews are also held with the placement authorities and residents families. Residents consulted expressed little or no interest in the development and review of their care plans, but felt that they could ask to see what is recorded about them at any time. Some care plans had been signed by the residents when it had been first written. Individual risk assessments were in place, which covered the core areas of risks faced and posed by residents, and recorded the actions to manage any identified risks. However where decisions were reported to have been made to lock most doors at the home, fit bedrails and tilt beds to reduce harm or risks there was not always a risk assessment to support why these decisions had been made to restrict a residents freedom based on their safety. Records show that prompt action is taken to address any medical concerns, including the involving of any additional specialist services including dieticians, speech therapist and specialist nurses. Residents confirmed that when they have asked to see a GP staff have sought this promptly on their behalf. The staff nurse in charge confirmed that there are no significant pressure sores being treated at the home and spoke knowledgably about good practices they undertake to promote good pressure care management. When staff were asked what the home does best the vast majority felt that the home provides very good health and medical support. A resident who has a learning disability had a health action plan as part of their care plan, which clearly had helped to improve their overall physical health since being at the home. A relative also noted the clear improvements in their relative’s physical health since being at the home. The manager confirmed that they have recently attended training in pain recognition and management in people with learning disabilities. None of the residents accommodated are assessed to administer their own medication. Medication profiles are in place which provides information on how much medication is provided, how medication should be administered and Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 16 when it is administered. Only nursing staff dispense medication. Medicines were well organised and stored. However, there was no explanation provided for gaps on a medication profile form to indicate why a prescribed medication had not been dispensed the day before. Although the nurse on duty felt that this could be explained this needed to be recorded to evidence why the prescribed instructions were not followed at the time, which the nurse agreed to undertake immediately. At the time of viewing the medication profiles there was not always additional instructions on “as directed” medication to ensure that staff had the guidance to be able to administer these medicines in accordance with the individuals requirements, however the manager confirmed that this information is in place and agreed to recheck in case these had been temporally misfiled. During the inspection staff were seen to be respectful towards residents. A resident fedback “always knock on the door”. Staff consulted with showed an understanding of good practices in preserving resident’s rights to privacy and dignity. Staff were able to give examples of how they promote these rights in their every day care practices. Residents were observed to be dressed in well laundered clothing and enjoyed the regular input from the visiting hairdresser to help maintain their appearance. Observational windows were in place in the ground floor bedroom doors with the vast majority either fitted with a frosted film or curtain. One example was noted whereby neither of these measures had been fitted, which meant that the occupant of the bedroom could be observed by anyone walking past. The manager agreed to address this immediately and therefore no requirement was made at this stage to improve the resident’s privacy and dignity. The manager categorically confirmed that at no time are the curtains left open on these windows, but remain in situ until new doors are fitted following the planned extension of the home. Staff spoke sensitively about the care and support provided to residents and their families when residents have become terminally ill. Staff gave examples of how well the home manages end of life care and have a range of equipment and access to specialist medical support Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most resident’s lives are enriched by the provision of a good range of social activities, however due to the wide range of needs and ages being accommodated further work is needed to improve the social, developmental and community opportunities for residents with a learning disability or mental health needs. Links with families and friends are valued and supported by the home. Residents are generally able to exercise some choices over their daily lives, however further work is needed to ensure that any restrictions on movements are based on appropriate assessments to promote residents rights. The meals offered choice and variety and catered for special dietary needs, however not all residents received a suitable meal time experience. EVIDENCE: Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 18 Resident’s views regarding activities varied between those who enjoy socialising and others who were not so interested, however all residents confirmed that their preferences were respected by staff. A full time activities co-ordinator is employed who undertakes a flexible range of activities including craft sessions, painting, sing-along’s, board games, aromatherapy, manicure and parties. The activities co-ordinator was clearly enthusiastic and some residents were observed enjoying their company in a sing along. The home has its own transport to enable outings to be undertaken to local shops, cafes and weekly horse riding. Although some excellent examples were noted of occupation opportunities for some residents it was not always clear what the stimulation, community access, developmental and social opportunities were being provided to residents with a learning disability or mental health needs. The activities co-ordinator spoke of doing some sensory work and a resident going to a show which they particularly enjoyed. The manager spoke of day services being developed nearby which it is anticipated some residents with a learning disability will be attending. A resident spoke of going for drives out with staff, going out for coffee and undertaking some “colouring” but felt “bored” most of the time as the activities did not suite their age or level of understanding. They spoke of there not being any internet connection at the home in order to keep in contact with friends or be able to use the web. Another resident spoke of their frustration of only being able to watch a few TV channels due to the poor ariel reception at the home. Relatives fedback how welcomed they are made to feel when they visit, this included being offered beverages or meals and how they can visit at any reasonable time. Most relatives consulted with spoke of the good standard of communication with the home and are kept up to date with any significant changes in needs. Through observation and discussion with residents and staff, staff try and accommodate residents individual preferences with regard to rising, meals and going to bed. A resident said “free to get up and go to bed when I want”. The manager confirmed that one resident has an advocate to help them make informed decisions. The manager had recently made a “deprivation of liberty” application to ensure that a resident’s rights were not being restricted through actions requested by a relative. Residents are not free to move around the premises due to some corridor, bedroom and the quiet room doors being locked. A resident said “it is run like a secure hospital and that it is embarrassing having to ask for doors to be unlocked”. The type of locks used are chub locks with several bedroom doors noted to have this lock on the outside only. The manager categorically confirmed that these are never locked while residents are in their bedrooms. Two residents said that they have their own chub key and like to lock themselves in their bedroom, both saying this is the only way to stop other residents from entering. As previously noted any restrictions on a residents Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 19 rights needs to be underpinned by the appropriate assessment either via risk, capacity or deprivation of liberty assessments in the individuals care plan. The lunch time and supper meals were partially observed. Various meal time arrangements were in place with a group of seven residents eating their meals in reclining lounge chairs in the conservatory, others in their bedrooms and the remainder in the pleasantly decorated dining room. Lunch time was clearly a busy time with the majority of residents requiring some level of assistance to eat and drink and although this was done in gentle manner staff were interchanging their support between residents which did not promote continuity or orientation for the resident. A consistent approach was also needed from staff when a resident seeks additional food to ensure that they are clear on any reasons why this is not advised. The environment for residents sitting in the dinning room was not always relaxed, as one resident liked to show their happiness through regular shouting which a resident described as “frightening” another resident said that this made them very nervous. The manager felt that it would not benefit or assist in residents orientation for those seated in the conservatory to eat their meals at a table. The lunch time meal finished at 2pm. It is recommended that the meal time arrangements be reviewed to help address the issues of varying needs and preferences of residents and promote continuity in support. The meal presented was appetising, there was an alternative choice of main meal if a resident did not like the main option. The chef was aware of good practices in the presentation of liquidised meals and plated the meals in the dinning room himself and was therefore able to gain direct feedback on the food and on resident’s individual preferences. The chef spoke of providing sugar free supplements to diabetic residents. Much work has been undertaken with nutritionists to ensure that a resident received a sufficient diet. Nutritional assessments are undertaken and where concerns are highlighted additional supplements are provided. Residents generally spoke positively about the food with particular reference to the provision of hot suppers. A sample of comments about the food included “food very good” “lovely” and “not particularly appetising”. An orientation board is used to display the written menu, to further promote good practices it is recommended that the menu also be available in a format suitable for all residents being accommodated to be able to access and make choices from. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using 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. There is a complaints system with evidence that residents and the majority of relatives consulted feel that their views would be listened to, with some further work needed to ensure the procedure is accessible to all residents. Staff have the guidance and training necessary to show them what to do if there are concerns about the wellbeing of residents. EVIDENCE: There is a complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. All resident and all but one relative consulted with said that they felt able to share any concerns they had with the manager and where they have raised minor issues, this has been addressed promptly. Relatives commented “they listen to concerns and act on them” and “act promptly when a problem is noted”. A relative spoke of their frustration of pre arranged meetings to air any concerns they had being cancelled. In order to promote the complaints process being accessible to all it should also be available in a format suitable for the needs of residents being accommodated at the home. The home has written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 21 the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with have received formal training in safeguarding adults and prevention of abuse and showed an understanding of their roles and responsibilities under safeguarding adult’s guidelines. A staff member said “we never ignore what you see or is said to you” Where safeguarding referrals have been made the home has followed the appropriate guidance and has responded in a timely manner to any information requests from external agencies. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 24 25 and 26 People using the service experience adequate 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 clean and homely environment, however there are some restrictions on the building being able to address the full range of residents needs due to its layout, size of some bedrooms and it being a listed building which are largely due to be addressed through a further extension of the home. This will also create distinct living areas for people who have a learning disability and other specialist needs being catered for. Residents have a range of specialist equipment and adaptations to aid mobility and independence around the home and includes a call bell system which enables them to call for assistance if needed. EVIDENCE: Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 23 The home is a large period property which has been extended over the years. The provider reported that they have been awaiting planning permission to extend and improve the property for six years and the frustration that the continuing delays have had in wanting to improve facilities at the home. Currently residents of varying needs are accommodated throughout the home and the plan is to add further bedrooms and provide distinct areas/units for people who have dementia, learning disabilities and mental health. This arrangement will then enable much more focused support on the specialist needs of residents and help to reduce some of the current frictions of such a wide group of residents needs living altogether. Two residents spoke of their frustration of the challenging behaviour of some residents and how this affected their own quality of life, from doors being locked to limit movement to locking their own door to prevent other residents coming in. Variable feedback was received regarding the standards of accommodation. A sample of comments included “there is a need to improve the ambience, better furnishing, office space and the communal areas are a bit dated as are bedrooms” “environment seemed ok it was clean but a bit small in places, not the most modern but homely” “the building is not ideal very small bedrooms” and “the lightening is poor in places as they use low wattage bulbs” Much effort is made in communal areas to create a homely feel. The use of pictures to identify toilets and bathrooms helps to aid orientation for some residents. There is a well maintained garden with a crazy paving patio area and some seating. A sensory garden has just been landscaped which includes raised beds and provides level access. Residents are encouraged to personalise their bedrooms, however some bedrooms for younger people did not always reflect their needs or age. Many of the bedrooms appeared dark with small period windows and dark furniture and curtaining. Some bedrooms had been fitted with lino flooring to help manage continence. A resident described their bedroom as “you can’t swing a cat in here”. A resident spoke of their frustration of not being able to get a “decent TV picture”. The manager confirmed that the building is listed and therefore there are restrictions on being able to add further ariels to boost the signal. Some bedrooms look out across the garden and countryside. A resident spoke of their bedroom overlooking the kitchen and the noise and smell from there can be unpleasant at times. The manager was very mindful of the restrictions placed by the building and the size of some bedrooms, when assessing new residents. Resident’s bedrooms are presented across the three floors with two bedrooms in the attic where the three occupants of these bedrooms remained during the course of the inspection, as they felt unwell. Staff said they popped in throughout the day to ensure they did not become isolated. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 24 As previously noted ground floor bedroom doors are fitted with observational panels with all but one being covered, it was confirmed that these will be replaced with sold doors as part of the planned extension to the home. There is sufficient number of toilets and assisted bathrooms located around the home, including the majority of bedrooms providing toilet en suite facilities. A new wet room is near completion, which has been refurbished to a good standard. There is a range of individual aids and adaptations to assist resident’s mobility and independence including walking aids, height adjustable beds, raised toilet seats, grab rails, reclining chairs and hoists. There is a call system fitted throughout the home, which enables assistance to be summoned when pressed. Residents consulted in their bedrooms had their call points placed within easy reach and confirmed that their calls for assistance are answered promptly by staff. All areas inspected were observed to be cleaned to a good standard with residents and relatives confirming that the home is always kept clean with any unpleasant odours confined to a few bedrooms. Systems were in place for the control of infection and staff said that they have been trained in this area and were observed to be working in ways that minimised the risk of infection through the use of protective clothing with all staff confirming that they had easy access to protective clothing. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 and 30 People using 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. Staff contribute positively to the quality of life of residents, through their personal qualities and having most of the training and skills they need to be able to work safely and effectively with most residents. Residents are being protected by the home’s recruitment policy and practices which helps to ensure that only people who are safe to work with vulnerable people are employed. EVIDENCE: The staffing structure is currently for a minimum of six care assistance and one nurse in charge during the waking day, in addition to management, administration and domestic staff. Variable feedback was received regarding whether staffing levels were sufficient all residents consulted felt that there was. Feedback from staff and relatives included: “they need more staff” “improve staff sickness which has a negative impact on staffing levels. They do try and cover shifts but not always possible at the last minute” and “I do feel it is enough staff if everyone turns up”. The manager confirmed they monitor staffing levels and would seek approval with the provider to increase staffing levels if they felt levels needed to be changed. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 26 There is a core group of staff who have worked at the home for a number of years and who showed a good understanding of the nursing needs of residents. Many positive signs of interactions were noted between staff and some residents. This included smiling, touching and initiating conversation and recognising staff members voices. Humour was observed being used to support a resident to eat which they clearly responded to. Without exception all persons consulted spoke positively about the caring qualities of staff and a sample of their comments included : “staff all very nice and helpful” “the care given is second to none” “staff very good helpful and kind” “staff have a lot of patience” “staff are very caring and friendly” and “really nice staff you can have a laugh with some of them”. The home has been proactive in ensuring that more than half the staff have completed a National Vocational Qualification (NVQ) in care. Staff consulted with confirmed that they have undertaken all of the areas of mandatory training needed for them to work safely with residents. This includes manual handling, first aid, safeguarding adults and food hygiene. Some specialist areas of training have also been undertaken this includes dementia, pain recognition in people who have a learning disability. Staff spoke of undertaking some training in learning disabilities but have not yet received training in mental health conditions. There is currently no nurse with a learning disability background. The manager was aware of the need to provide additional specialist training in mental health, person centred planning and some further areas of learning disabilities and was in the process of seeking out suitable training, therefore no requirement is made relating to this at this stage. The manager confirmed that new staff undertake the industry recommended minimum inductions standards. This is designed to help ensure that all new staff entering into the care industry have a minimum level of initial training. Good practices were noted with the introduction of a system for establishing staff members understanding of the training they have attended through questionnaires to help ensure the transfer of the training into good practices at the home. Recruitment files of three staff were inspected and these showed that a robust recruitment process is followed which includes the use of an application form, interviews, and written references prior to employment commencing. The organisations human resources confirmed subsequent to the inspection that all Criminal Records Bureau (CRB) checks are completed and held by them to help ensure that only staff who are suitable to work with vulnerable people are employed. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 and 38 People using 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. Resident’s benefit from an approachable manager who is an experienced nurse and who provides a good sense of direction and ethos to help promote good care practices. A range of regular health and safety checks helps to promote the health and safety of residents and staff. The home regularly reviews aspects of its performance through a program of self-review and feedback. EVIDENCE: Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 28 The manager has been the registered manager since November 2007, prior to this they were the deputy manager and had also been the manager of the home in the mid 90’s. They are a registered mental nurse with many years nursing and managerial experience. They confirmed they have undertaken the recommended management qualifications and keep themselves updated in changes in legislation and good practices guidance by regularly attending further training. The manager demonstrated a good understanding of the areas in need of improvement at the home, the daily running of complex nursing service and was open in their dialogue with the inspector. Consistent feedback was received regarding their approachability and hands on nature. A sample of comments included: “manager met a couple of times very pleasant knew what she was talking about” “very helpful” and “very supportive”. Members of the organisation take responsibility for the finances, human resources, decoration and quality assurance aspects. The providers visit regularly with the head office of the organisation within the grounds of the home. Although this provides some valuable expertise in these areas it was not always clear the level of autonomy the manager has and the lines of accountability. For example in determine staffing levels, décor and setting budgets. There are many mechanisms in place for the home to obtain feedback on the quality of the services provided and whether it is achieving its aims and objectives. There is a quality assurance manager who was clearly very enthusiastic in their role and takes the lead on monitoring the services and facilities provided and undertakes yearly satisfaction questionnaires, monthly quality reports, cleaning schedules and internal quality audits. They also undertake the required monthly audit of the services and facilities and complete a written report on their visit. Many examples were noted of the changes that have been made to practices in response to feedback this has included menus, activities and laundry practices. In order to provide an inclusive approach to involving all residents in obtaining their feedback surveys should also be provided in a format that is accessible to the range of residents needs being accommodated. The quality assurance manager agreed to undertake this. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible person external to the home. The manager confirmed that they do not act as appointee for anyone. Care staff spoke of receiving formal supervision and direct supervision through working alongside nursing staff and felt well supported by them to undertake their role. Nursing staff spoke of the clinical supervision they receive from the manager Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 29 Written guidance is available on issues related to health and safety. Records submitted by the manager stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. The manager reported that no recommendations were made from the last visit by Environmental Health. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment has been completed by a fire safety officer. The manager confirmed that this records any significant findings, the actions taken to ensure adequate fire safety precautions in the home and are in the process of developing individual plans of evacuation. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 30 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 2 2 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 2 2 2 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 3 x 3 x 3 3 x 3 Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 31 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 OP7 Standard Regulation 15(1) Requirement Timescale for action 30/12/09 2 OP7 13(4)(c) 3 OP12 16(2)(m) & 16(2)(n) That care plans provide clear guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs in an individual way. That written personal risk 30/12/09 assessments are completed for all service users which are reviewed regularly and records the actions to manage identified risks in relation to their own safety through free access around the building, use of bedrails and tilted beds. That further opportunities are 30/01/10 provided for service users to participate in valued and fulfilling activities which includes local social and community based activities in accordance with residents individual preferences and needs. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 32 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 OP2 OP15 OP15 Good Practice Recommendations That all service users are provided copies of the homes terms and conditions of residency. That menus are presented in a format for ease of understanding recognising in order to further promote choice for residents. That the meal time arrangements be reviewed to help address the varying needs of residents and preferences of residents and to help promote continuity in support. Chaldon Rise DS0000013307.V378286.R01.S.doc Version 5.3 Page 33 Care Quality Commission Care Quality Commission South East Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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