Care Home: Chargrove Lawn

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What the care home does well At the last inspection we found: Chargrove Lawn provides a welcoming atmosphere for visitors. We saw some good examples of care and support being given to residents, and people generally spoke positively about their care and the way in which staff looked after them. People`s families and friends are encouraged to join in the life of the home, and people can maintain their outside interests and contacts as well. Families are also able to remain involved in the care of their relative residing in the home if this is wanted. The diversity amongst people is respected, and they are supported to make personal choices. We have no reason to believe these outcomes have changed. Surveys from people living in the home stated, "the home is warm and the gardens are well maintained," and "the care I receive is great fells very safe and secure here and I feel I can ask for help if needed." Staff surveys commented that induction and training was good. A comment that "we look after the clients and their needs very well" was reflected in most surveys from staff. What the care home could do better: When new people are admitted the activities of daily living assessment should be completed. All people living in the home should have risk assessments which describe how hazards are minimised. Written evidence that accidents and incidents are being monitored should be provided. Arrangements for the administration and storage of medication need to be improved to safeguard people from possible harm or error. Fire exits must be kept clear of obstacles. The kitchen ceiling needs to be cleaned and areas of the home need a spring clean. An extractor fan in a first floor bathroom needs to be fit for purpose. New staff must not be appointed unless all records as required by us have been obtained. This includes a full employment history, two references, evidence that a CRB check has been completed and proof of identity. The manager must submit an application to us to go through the registration process. Random inspection report Care homes for adults (18-65 years) Name: Address: Chargrove Lawn Shurdington Road Cheltenham Glos GL51 4XA one star adequate service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lynne Bennett Date: 2 6 0 5 2 0 1 0 Information about the care home Name of care home: Address: Chargrove Lawn Shurdington Road Cheltenham Glos GL51 4XA 01242862686 01242862686 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Christine Mary Martin Type of registration: Number of places registered: Conditions of registration: Category(ies) : CTCH Ltd care home 26 Number of places (if applicable): Under 65 Over 65 26 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 26 The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Chargrove Lawn is a care home registered to provide personal care for 26 older people. In cases where nursing care is needed, it is accessed from community sources.The home is part of the CTCH Ltd group of homes and is set in a semi-rural location on the outskirts of Cheltenham. The home has been adapted from a large Care Homes for Adults (18-65 years) Page 2 of 12 Brief description of the care home domestic residence and has two purpose built extensions. Single rooms are provided throughout, with a minimum of an en-suite toilet. The home is arranged on two floors with a shaft lift providing access to the first floor. There is a large amount of communal space for residents use including three lounges, one of which includes the dining area, and there is a garden room adjacent to the hairdressing salon. There are gardens to the side and rear of the property with patio area and garden furniture. A ramp allows easy access for people who use wheelchairs. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Chargrove Lawn range from GBP490.00 to GBP544.00 per week, and the home also provides care at the basic Local Authority rate of funding where applicable. Hairdressing, Chiropody, Opticians, Newspapers, Toiletries and Transport are charged at individual extra costs. Care Homes for Adults (18-65 years) Page 3 of 12 What we found: This random inspection took place in May 2010 and included a visit to the home on 26th May. The manager was present throughout. She had completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We had received surveys from 6 people living in the home and 6 members of staff. The inspection focused on the requirements issued at the last inspection, case tracking two new admissions including their medication records, examining recruitment and selection documents for two new members of staff and notification and accident records. We were also shown around the communal areas of the home and looked at some peoples rooms. We examined records for two people recently admitted to the home. One person was privately funded and had a full assessment of need completed by the home during a visit there. This was supported by an assessment pack completed by their family. The latter document provided information about their background and personal information about memories, hobbies and their lifestyle choice. An activity of daily living assessment which the home normally completes was blank. The other person was funded by a placing authority in Lancashire and they had provided an assessment of need and care plan. This was supported by discharge information from a hospital as well as their goal plans. The registered manager said they had been unable to visit to complete an assessment prior to the move. The activity of daily living assessment had been completed as well as the assessment pack completed by relatives. Both families had acknowledged that they had received a copy of the homes service user guide and the terms and conditions. A letter confirmed funding arrangements for the person who was privately funded. The AQAA stated, potential residents and their families are encouraged to visit without prior notice so that they can view the home during a typical day. Care plans had been put in place for both people which reflected their physical, emotional, intellectual and social needs. Plans were clear and succinct and person centred reflecting peoples wishes. One personal care plan indicated the persons preferences for the gender of staff providing their personal care as highlighted in their assessment. The other persons personal care plan stated that two people were needed to help them with their personal care but did not indicate whether they had any preferences about their gender. Care plan review records had been put in place ready for an evaluation of peoples needs. Where changes to need had already occurred new care plans had been put in place. The manager said that she was reviewing all care plans to make sure that information was current and up to date and renewing care plans where needed. There were no risk assessments in place for either person and the manager acknowledged that these needed to be put in place as soon as possible. One person was at risk of developing pressure sores. A care plan was in place describing the support needed to prevent this and the necessary tissue viability risk assessment had been completed. The support of a District Nurse had been sought promptly when concerns arose and the appropriate equipment provided. Referral to a dietician had also been made when concerns about diet and weight loss arose. Care Homes for Adults (18-65 years) Page 4 of 12 The home was keeping accident and incident records for people and producing a monthly audit. It was clear that some people were having re-occurring incidents but it was not evident how these were being monitored. The manager said that her line manager had identified this shortfall during a recent Regulation 26 visit. The manager was monitoring these incidents and taking the appropriate action but had not recorded this on the audit record. We had been informed about incidents and accidents which were notifiable under Regulation 37. Medication systems for the administration of medication were inspected. The home uses a trolley which was secured to the wall although the screw was loose and when tested came away from the wall. The small Controlled Drugs (CD) cabinet was loosely attached to the wall. These do not comply with the Misuse of Drugs (Safe Custody) Regulations 1973 so consideration must be given to upgrading this so that the correct storage is in place. We observed medication being administered and staff followed satisfactory procedures giving the medication to people and signing the medication administration record (MAR) only when it had been taken. One person refused medication and this was entered on the MAR and into another record book. Refused or spoiled medication was put into a container in the trolley. We advised the staff member to make sure this container was regularly emptied and contents returned to the pharmacy. Staff confirmed that where people regularly refuse medication they are promptly referred to the General Practitioner (GP) for advise and monitoring. People living in the home had agreed to the use of homely remedies but evidence could not be found that the GP had also confirmed that they could be used. The temperature of the medication cabinet was not being monitored. Creams and liquids were being labeled with the date of opening and stock records were being maintained. Medication audits were taking place each month and staff said any shortfalls with recording were being identified and the relevant action taken to promote better record keeping. The MAR charts were satisfactory during our visit. We walked around the environment which was clean and tidy. A new housekeeper had just been appointed. Areas of the home needed a spring clean with some cobwebs in communal areas and the kitchen. A brick was observed outside a fire exit. This must be removed to prevent slips and trips. An Environmental Health visit in May had identified concerns and some recommendations had been made. The ceiling of the kitchen is in need of a deep cleaning treatment. People have access to spacious lounges and a dining room. There are quiet lounges and a conservatory as well as access to a well maintained garden. People have recently been involved in a gardening club as part of the increased access to a range of activities. Some rooms have en suite facilities which may include baths or showers. Rooms were being redecorated for new people moving in and some corridors had been redecorated. The first floor bathroom provided an assisted bath. One person had mentioned in their survey that there were no shelves on which to place personal items when bathing. An extractor fan in this bathroom was not working and the room was extremely hot during our visit. A person also mentioned that water jugs provided in their rooms are too heavy for frail people to use. The manager said that staff pour water into glasses for some people but may need to offer this for all. We looked at the files for two new members of staff. Both had completed application forms. There were gaps in employment history for both staff members which had not been explored with them. For one applicant it could be ascertained that they were bringing up children. Where there are gaps in employment history these need to be investigated and evidence provided on their records. References had been requested for both applicants. Two references had been provided for one applicant prior to starting Care Homes for Adults (18-65 years) Page 5 of 12 work. It appeared that the other applicant had only one reference in place. The manager stated that she had received a verbal reference from one employer who had refused to give a written reference. She had obtained a further reference from another employer but this could not be found during our visit. There was evidence that an ISA (Independent Safeguarding Authority) check had been received for both applicants. There was no evidence that Criminal Records Bureau checks had been received apart from one entry on a checklist for one person. The manager said these were kept at Head Office. She said neither person had started work before the CRB check had been returned. Proof of identity was in place for one applicant but not for the other. Evidence that staff had completed an induction was on their files as well as certificates for other training. The AQAA stated that all new staff undertake a CIS skills scan to check that they are meeting the common induction standards. Staff confirmed they are doing lots of training currently including food hygiene, mental capacity act and infection control. Records indicated that new staff were completing a probationary period and having monthly supervision sessions. The manager has not yet applied to become registered with us. An application to become the registered manager must be made as soon as possible. All requirements issued at the last inspection were met and one partially met in relation to the kitchen. A new requirement in respect of the kitchen has been issued. What the care home does well: What they could do better: When new people are admitted the activities of daily living assessment should be completed. All people living in the home should have risk assessments which describe how hazards are minimised. Written evidence that accidents and incidents are being monitored should be provided. Arrangements for the administration and storage of medication need to be improved to safeguard people from possible harm or error. Fire exits must be kept clear of obstacles. The kitchen ceiling needs to be cleaned and areas of the home need a spring clean. An extractor fan in a first floor bathroom needs to be fit for purpose. New staff must not be appointed unless all records as required by us have been obtained. This includes a full employment history, two references, evidence that a CRB check has been completed and proof of identity. The manager must submit an application to us to go through the registration process. Care Homes for Adults (18-65 years) Page 6 of 12 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 2. Care Homes for Adults (18-65 years) Page 7 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 12 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, 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 9 13 The registered person must 30/06/2010 make sure that medication is stored securely and safely in line with the Misuse of Drugs (Safe Custody) Regulations 1973. This is to safeguard people from possible harm. 2 19 23 The registered person must 31/05/2010 make sure that the home is compliant with the Regulatory Reform (Fire safety) Order 2005. This is in relation to keeping fire exits clear of obstacles. This is to prevent people being harmed. 3 19 23 The registered person must 31/08/2010 make sure that the kitchen ceiling is clean and free from dirt or dust. This is to promote good infection control procedures. 4 21 16 The registered person must make sure that there is 30/06/2010 Care Homes for Adults (18-65 years) Page 9 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 adequate ventilation in bathrooms. This is to make sure that facilities are fit for purpose. 5 29 19 The registered manager must make sure that staff are not appointed until all information and records as required by us are in place. This is in respect of a full employment history, two written references and evidence of a CRB check. This is to safeguard people from possible harm or abuse. 6 31 8 The registered manager must submit an application to the CQC to be considered for registration. This is to confirm that the manager is fit to manage the home under our legislation. 7 38 13 The registered manager must make sure that any hazards to people living in the home are assessed and risk assessment produced. This is to safeguard people from possible harm. 30/06/2010 30/06/2010 30/06/2010 Care Homes for Adults (18-65 years) Page 10 of 12 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The activities of daily living assessment should be completed for all new people moving into the home and reviewed on a regular basis. Evidence should be provided that the use of homely remedies has been agreed with the GP or Pharmacist. Stocks of spoiled or refused medication should be kept to a minimum and regularly returned to the pharmacy. Areas of the home should be spring cleaned to remove cobwebs. Communal bathrooms should provide space for storage of peoples personal possessions. Proof that the identity of new staff has been checked should be evidenced on staff files. Evidence should be recorded that accident and injury records are being monitored and action taken in response to the findings. 2 3 4 5 6 7 13 13 19 21 29 38 Care Homes for Adults (18-65 years) Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: 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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