Care Home: Chardwood Rest Home

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What the care home does well Potential new residents benefit from a through pre- admission assessment that allows for only those who needs can be met, being admitted to the home. The health needs of residents are well met with evidence of good multi disciplinary working taking place. Staff provide personal support to residents in such a way that promotes and protects residents privacy and dignity. Residents experience mealtimes that are unhurried, whilst all meals are home cooked with an alternative option being available for each mealtime. Resident`s can be assured that there is an efficient complaints procedure in place and that the homes processes and staff training should protect residents in the event of an allegation of abuse. The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to residents. Resident`s experience the benefits of a staff team that have the necessary skills and experience to the meet their needs. Staff training meets the National Minimum Standards and is appropriate to the level of needs of current residents. The management and administration of the home is good, with evidence of consideration being given to residents and relatives opinion at all times. What has improved since the last inspection? Advise has been sought from the Environmental agency with regards to unguarded radiators. What the care home could do better: Care plans are in need of being generated with the involvement of the resident and/or their representative, in order to ensure that the home is fully aware of all the residents needs and current limitations. Where the resident chooses not to be present, this should also be clearly recorded. Risk assessments require expanding to be specific about the risk element and the actions to be taken by residents and staff to minimise the potential risk and/or hazard. It is recommended good practice that a staff signatory list is included in the medication file. Daily care record entries should also be expanded upon, in order to be clear and factual. In order to further safeguard staff and residents, personal allowance account transactions should be signed for by two persons. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chardwood Rest Home 127 Eastbourne Road Pevensey Bay East Sussex BN24 6BN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rebecca Shewan     Date: 1 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Chardwood Rest Home 127 Eastbourne Road Pevensey Bay East Sussex BN24 6BN 01323766058 01323760983 roland@richardson65969.freeserve.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Roland Richardson,Mrs Mary Richardson care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Service users will be aged sixty-five (65) years or over on admission. The maximum number of service users to be accommodated is fifteen (15). Date of last inspection Brief description of the care home Chardwood is a care home for fifteen (15) older people. The home is within walking distance of the beach, half a mile from the village of Pevensey Bay and approximately 4 miles from the town of Eastbourne. The home provides thirteen (13) single rooms, eleven (11) with en-suite toilet and wash-hand -basin facilities and one shared bedroom. There are two assisted baths and one assisted shower facility. The home provides several communal areas, including a conservatory, a dining room, a lounge and a patio area in the garden. There is a passenger lift to access the first floor accommodation. A copy of the Statement of Purpose and Service Users Guide is available to view in the home. At the time of the inspection fees were documented to be between £342.00 and £430.00 per week. Additional charges are made for hairdressing, chiropody, toiletries and newspapers. Care Homes for Older People Page 4 of 25 Over 65 15 0 Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place during the morning and afternoon of the 13th January 2009. The Annual Quality assurance assessment (AQAA), incident reports and previous inspection reports, held by the Commission for Social Care Inspection, were read before the inspection. The inspection of the home took five hours. Records such as care plans, staff files and medication records were also viewed. Fourteen service users (known as residents) were accommodated at the home at the time of the inspection. A tour of the whole home was undertaken and the Registered Manager, two Carers and a Cook and three residents were spoken with. The CSCI also conducted Service User and Staff surveys. Of which six Service User and ten Staff surveys were received. The Care Homes for Older People Page 6 of 25 responses from the surveys received, were positive in all areas relating to the home and the care provided. What the care home does well: What has improved since the last inspection? What they could do better: Care plans are in need of being generated with the involvement of the resident and/or their representative, in order to ensure that the home is fully aware of all the residents needs and current limitations. Where the resident chooses not to be present, this should also be clearly recorded. Risk assessments require expanding to be specific about the risk element and the actions to be taken by residents and staff to minimise the potential risk and/or hazard. It is recommended good practice that a staff signatory list is included in the medication file. Daily care record entries should also be expanded upon, in order to be clear and factual. In order to further safeguard staff and residents, personal allowance account transactions should be signed for by two persons. Care Homes for Older People Page 8 of 25 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There a good processes in place for assessing potential new residents with services being offered to only those residents whose needs can be met. Evidence: Documentation relating to the most recent admissions to home were viewed and found to have been completed fully and conducted with the involvement of the resident and/or their representatives (where applicable). The homes Registered Manager carries out pre- admission assessments. Copies of care management assessments from the placing authority are obtained, where these exist. The Registered Manager addresses any issues, which are highlighted within this assessment. Intermediate care is not provided by this home. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered a good provision of health care and personal support. Risk assessements require updating to ensure that all necessary precautions are taken to ensure that risks are minimised. Care plans are good and provide clear guidance to staff, with some improvements required to ensure that residents are included in the care planning processes. All care is administered in way that protects their privacy and dignity. Evidence: Care plans set out in detail the action which needs to be taken by care staff, to ensure that all individual health, personal and social care needs are met in a structured and consistent manner. Care plans were sampled and it was evidenced that they were detailed in content and covered all aspects of residents needs. Residents involvement in the care plan review process was not evident. Therefore a Requirement has been made. Risk assessments for falls and Moving and Handling were viewed. Falls risk assessments were found to be basic in content and did not provide clear risk management guidance for staff. Entries made included: Activity - chair, hazard Care Homes for Older People Page 12 of 25 Evidence: falling, person in danger - resident, measures - be aware of position and Activity footstool, Hazard - tripping, Person in danger - resident, Measures - none required. Therefore a Requirement has been made. Daily care records are also maintained and these were viewed. It was observed that some entries were signatures only and some entries were personal in content i.e. (residents name) wanted to take canderal up with her, bless!!! and some entires were contradictory i.e. (residents name) seems fine today, not feeling too good. Residents are registered with one of seven GPs based at a local GP surgery. District Nurse and Occupational Therapist services are available to the home and attend to residents as needed and are accessed either directly by the staff of the home or via the GP. Residents can attend one of the local Optician clinics and/or home visits can also be arranged. Dentist treatment is arranged via private and/or NHS surgeries. There are both types of surgeries available locally. Access to audiology and physiotherapy are sourced via GP. The home has a Chiropodist who attends the home every six weeks and as required. The home has good procedures in place for the monitoring and recording of all drugs administered, disposed of and those entering and leaving the home. The stores for medication were viewed and these were found to be maintained in a clean and orderly manner. Medication administration records were viewed and these were found to be maintained appropriately. It was observed that unexplained, undated and unsigned handwritten entries had been made onto Medication Administration Recording (MAR) sheets, this information is sourced in the daily care records. It was discussed with the Registered Manager that this information should also be transcribed onto the MAR sheet, in order to provide a clear audit trail. The Registered Manager reported that all future entries would be transcribed in this manner. Staff were observed providing personal support to residents in such a way that promoted and protected their privacy and dignity. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of social and recreational facilities. Menus and meals including specialist diets are designed to meet residents needs. Residents choice and wishes are respected in all activities and mealtimes. Evidence: Residents are consulted regarding their social and leisure interests and an activities programme is implemented to reflect those interests and preferences. Activities are arranged on a daily basis according to residents choice, there is a not a published list. The Registered Manager reported that this is the current residents choice and should new residents move in their wishes, regarding activities, would be taken into consideration. Records are maintained of all activities conducted. Activities include birthdays and seasonal events celebrated, board games, music and motivation, quizzes, crosswords, Film afternoons, arts and crafts, and music therapy. Residents spoken with said that they liked most of the activities and could pick and choose those that they attended. One resident commented that they wish more people would come to them as they are great fun! A hairdresser attends the home once a week. Residents religious wishes are observed and arrangements are in place for residents to Care Homes for Older People Page 14 of 25 Evidence: receive non denominational Holy Communion, if they wish. One resident is assisted to attend the local church. There are currently two day centre attendees at present. Contact with family and friends is positively encouraged with visitors being able to attend the home at any time and in accordance with the residents wishes. The homes menus are devised on a four week rolling programme. All meals are home cooked with an alternative option available for each mealtime. Mealtimes can be varied upon request and residents guests are also welcome to have meals at the home. Meals can be taken in the residents bedroom or in the communal dining room. Medical, therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. The meal served during the inspection was ample in quantity and attractively presented. The lunchtime meal was observed to be unhurried. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a robust and efficient complaints procedure, whilst the homes procedures, processes and staff training should protect residents in the event of an allegation of abuse. Evidence: There is an established complaints procedure in place. The management of the home has received twenty one complaints within the past twelve months, all of which have been addressed. The complaints relate to: heating issues, seating arrangements (in the lounge and dining room) and general complaints about lost items of laundry and the shed being locked. Appropriate action was taken by the Registered Manager, to address the concerns raised. Criminal Record Bureau (CRB) checks have been carried out on all existing staff. Both CRB and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. Staff have attended training in the Protection of Vulnerable adults within the last twelve months. This was evident from the staff files were viewed. The Registered Manager is Train the Trainer qualified in POVA. A copy of the East Sussex County Councils Safeguarding Adults procedures is readily accessible to staff. There have been no Safeguarding Alerts raised by the home in last twelve months. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation provided for residents is well maintained, safe, hygienic and odour free. Infection control procedures are adhered to at all times. Evidence: The location and layout of the home are suitable for its stated purpose. The home is well maintained and all areas of the home, including the garden, are accessible to residents. The home has an ongoing plan of refurbishment in place. The garden is well maintained. Staff were observed adhering to infection control procedures. Staff records viewed confirmed that Infection Control training has been provided for all staff. The home was clean and odour free throughout. There is a daily cleaning schedule in place. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health needs of residents are well met by a staff team that have the necessary skills and experience to the meet the needs of current residents. There is good maintenance of all staff recruitment files. Staff training meets the National Minimum Standards and ensures that staff receive training that is both current and appropriate to the needs of residents. Evidence: A competent staff team, sufficient in number, meets the residents needs. There is a staff rota in place, which details staff hours of working. The home is staffed on the basis of two Carers in the morning, two Carers in the afternoon and one waking Carer overnight. There is a Housekeeper on duty during weekdays. The kitchen has a cook on a daily basis. The home has a permanent staff team of the Registered Manager, ten Carers, two Cooks and a Housekeeper. All carers are National Vocational Qualification (NVQ) level 2 trained. One Carer is currently completing the NVQ level 3 in care training. Staff recruitment files were viewed and it was evidenced that these files contain all Care Homes for Older People Page 18 of 25 Evidence: items required under the Care Homes Regulations 2001. The home has an Equal Opportunities policy in place and is an equal opportunities employer. Staff induction training is conducted in line with Common Induction Standards guidance. Mandatory training consists of Infection Control, Moving and Handling, Protection of Vulnerable Adults, medication, Induction, basic food hygiene and Fire Safety. Additional training has been conducted in Dementia. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents experience the benefits of a home that is well managed and administrated. Consideration is given to residents choice and opinion in all aspects of provisions provided. The health, safety and welfare of residents and staff are protected at all times. Evidence: The Registered Manager of the home is NVQ level 4 qualified and has achieved the Registered Managers Award. Both staff and residents commented in their surveys that Mr Richardson is always approachable, open to suggestions and is willing to listen. There is a formal quality monitoring and quality assurance system in place. Yearly audits are conducted, the results of which are are correlated and residents are told of the findings. Residents meetings are not currently held, this is at the residents request. The Registered Manager states that as residents see him on a daily basis they have asked not to have formal meetings. Staff meetings are also held every three to Care Homes for Older People Page 20 of 25 Evidence: four months. There is also a newsletter for Residents and visitors, which is published every three months. The home does not take any responsibility for many of the residents finances and most residents have family, friends or representatives who protect their financial affairs. Personal allowance accounts are maintained for four residents. The accounts were audited and nil discrepancies were noted. It was discussed with the Registered Manager that to further safeguard residents and staff, that all deposits and debits from accounts should be signed for by two persons. Therefore a Recommendation has been made. Staff spoken with and records viewed confirmed that staff receive two monthly supervision sessions with the Registered Manager. Staff also receive annual appraisals. The homes maintenance AQAA was viewed and it was evident that fire drills, fire alarm testing and fire equipment checks, health & safety checks and water checks are carried out. During the tour of the premises it was observed that unnamed bath products were in the shower and bathroom areas. The Registered Manager was advised of the risks associated with this and all products had been removed prior to the conclusion of inspection. No other health and safety issues were noted. The EHO visited the home in 2008, the recommendations made at the time of the visit have been actioned. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 That residents are involved in the care planning production and review processes. In that residents are not currently involved in these processes. Doing so would allow residents wishes to be met in a thorough manner. 13/03/2009 2 7 15 Risk assessments require updating to be more comprehensive in detail. In that current risk assessments do not give staff a clear overview of the risk and its management. Comprehensive risk assessments further reduce the risk of harm that residents may be exposed to. 13/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Older People Page 23 of 25 No. Refer to Standard Good Practice Recommendations 1 2 3 7 9 38 That daily care record entries are made in a detailed and factual manner. That a staff signatory list is incorporated into the medication file. That two persons sign for all transactions in residents Personal Allowance Accounts. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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