Care Home: Charing Court

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What the care home does well There is a relaxed and homely atmosphere. People say that the care workers are kind and attentive. They also say that they receive the support and assistance they need. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed. People`s medicines are handled safely so that they take them in the right way at the right time Sensible things are done to help prevent people having accidents. People are served with good quality meals. What has improved since the last inspection? Various bits of maintenance work have been done around the premises so that the accommodation remains homely. Arrangements have been made for work to start soon on extending the dining room, on making more space in the kitchen and on creating a proper staff room. Care workers have done various bits of training. Also a new work book has been introduced to help organise the introductory training that new care workers receive. What the care home could do better: Some people might like the chance to do more social activities. The complaints procedure needs to be strengthened. This is so that people are told about their right to tell us direct if there is something concerning them.There are some gaps in the training arrangements. This might result in some care workers missing out on opportunities to develop further their skills and knowledge. It might be possible to do more to fully involve the people who live in the Service in parts of the quality assurance system. This is important because they are the experts on what it is like to live in Charing Court. There are some shortfalls in parts of the fire safety arrangements. These might reduce the level of fire safety protection in the Service. CARE HOMES FOR OLDER PEOPLE Charing Court Pluckley Road Charing Ashford Kent TN27 0AQ Lead Inspector Mark Hemmings Unannounced Inspection 23rd February 2009 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charing Court Address Pluckley Road Charing Ashford Kent TN27 0AQ 01233 712491 01233 712776 amanda.demezieres@tesco.net 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) Songbird Hearing Limited Mrs Amanda Ruth De Mezieres Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th August 2007 Brief Description of the Service: Up to 33 older can make their home in Charing Court (the Service). The property is an older detached house thats been extended over the years. Everyone has their own bedroom. All of the bedrooms have a private wash hand basin. Ten of them also have their own toilet and bath or shower. There are two passenger lifts between the floors that give step free access around the accommodation. There is also a call bell system. There are call points in each of the bathrooms and toilets as well as in all of the bedrooms. This means that people can ring for assistance. The Registered Provider is a private individual. People who want to find out more about the Service and about the fees charged, can phone the Service and speak with the Manager. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was an unannounced Key Inspection. We arrived at the Service at about half past eight in the morning and we were there for about eight hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in his self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with five of the people who live in the Service and with four of their visitors. We also spoke with the Manager, a senior care worker, three care workers, the chef, the laundry manager, a housekeeper and the maintenance man. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we called to the Service, we asked ten of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Charing Court. Five people who live in the Service and seven members of staff kindly filled them in for us. Later on in our report, well tell you what theyre saying. The Registered Provider also asks the people who live in the Service and their relatives to fill out a questionnaire for him. This deals with a range of subjects that are similar to the ones we ask about. The most recent questionnaires were given out early last year. Later on in our Report, well tell you some of the things people who live in the Service are saying in their replies. What the service does well: There is a relaxed and homely atmosphere. People say that the care workers are kind and attentive. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 6 They also say that they receive the support and assistance they need. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed. Peoples medicines are handled safely so that they take them in the right way at the right time Sensible things are done to help prevent people having accidents. People are served with good quality meals. What has improved since the last inspection? What they could do better: Some people might like the chance to do more social activities. The complaints procedure needs to be strengthened. This is so that people are told about their right to tell us direct if there is something concerning them. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 7 There are some gaps in the training arrangements. This might result in some care workers missing out on opportunities to develop further their skills and knowledge. It might be possible to do more to fully involve the people who live in the Service in parts of the quality assurance system. This is important because they are the experts on what it is like to live in Charing Court. There are some shortfalls in parts of the fire safety arrangements. These might reduce the level of fire safety protection in the Service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 8 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 Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 3 and 6. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods will be helped to go back home. EVIDENCE: The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 10 moving into Charing Court is the right thing for them. She also talks with family members and with people like doctors and care managers (social workers). All of this is done so that she can build up a really good picture of how the person can best be supported. After shes got all of this information, she can then decide if Charing Court can meet the persons needs for help. We looked at the information that has been collected for one person who has recently moved into the Service. We wanted to see what sorts of things were considered. There is lots of useful information. There is stuff about practical things such as the help needed in the bathroom. But there is also other information about quality of life things. Such as how the person has problems with their hearing and needs things said slowly and clearly. The Manager says that when she gets the information she shares it with the care workers. This is done so that they know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Manager recognises that moving into a residential care setting is a big step for anyone to take. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the assessment process, people are invited whenever possible to visit Charing Court. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. We asked one person about their experience of moving in. They say, when I came here I visited first of all to see what the place was like and I liked it. There was a homely feeling to it and I thought that the staff were patient enough to put up with me! I have been quite okay here since and the staff really are that kind and take care of me. In our questionnaire for people who live in the Service we ask, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Five people say that yes they did and one person says no. One of the former people says that theyre, very satisfied. Nearly all of the people who move into the Service do so with the intention of making it their longer term home. However, there is the chance that someone will only want to stay for a shorter period. This might be so that someone who cares for them at home can have some time to themselves. Or, someone might move in because theyve been in hospital and arent quite ready to go home yet. When someone moves into a residential care setting theres always Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 11 the risk that their stay might become longer than is necessary. The Manager is aware of this. She says that she and the care workers will help people make any arrangements that are necessary for them to go home as planned. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 7, 8, 9 and 10. People are provided with the personal and health care they need. Medicines are handled safely. People are treated with kindness and respect. EVIDENCE: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to care workers so that they know what to do. We looked at four of these plans. They give a clear account of who needs to do Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 13 what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. In more detail, one person can loose confidence when theyre walking and they need to be reassured that they wont have a fall. Someone else needs to be supported to manage their continence. We asked four care workers about some of these things. We wanted to see if they know about this written information. They do know all about it and we saw them using it in practice. The Manager says that the plans are kept up to date so that they are accurate. This involves care workers making daily notes about how things are going. We checked these and they are being done. There are also more detailed reviews. This is when the Manager looks at the various records and generally checks things out. She does this to see how things are going and what might need to be changed. If necessary she invites family members and care managers to be a part of this process. Sensible steps are taken to ensure that people dont have any avoidable accidents. For example, some people have asked for rails to be fitted to their beds. These can be useful if someone is worried about rolling out of bed and hurting themselves. However, in other circumstances they can cause problems. The Manager is aware of this. She says that she has carefully looked into the needs of each person for whom the rails are currently being used. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, people have seen their doctors as and when they have needed to. There have also been visits by other professionals such as district nurses and chiropodists. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. In our questionnaire for people who live in the Service we ask, do you receive the medical support you need? Everyone says that they always do. People can do their own medication if they want to, but at the moment everyone has asked that the Service do it for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is given. We examined three sets of these records. They are correctly completed. We looked at two medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 14 There are special arrangements in place for some medicines that can be misused if they get out into the community. These arrangements include extra secure storage and a system to double check that the stock held in the Service is correct. When we were in the Service, we asked a number of people what they think of the care workers. They praise them saying that they are courteous and attentive. One person summarises the general mood when they say, I get treated really well here and the girls are so kind and helpful. Im quite settled here in my room and Im glad that I chose this place. I didnt know what to expect, well you dont do you, but its all turned out very well. In a similar vein, one of the visiting relatives says, we always notice how mother is very neat in her appearance and she never has dirty or creased clothes on. She would hate this as shes always been very particular and we appreciate the way that staff really help her to keep up her appearance. This is true for all of the other residents we see as well. In our questionnaire for people who live in the Service we ask, do you receive the care and support you need? Everyone says that they always do. We also ask, do the staff listen and act on what you say? Everyone says yes. The Registered Providers questionnaire asks, what do you think of the quality of care provided by the matron and the care staff, are you treated with respect and dignity? Everyone says that they are very happy or satisfied. Another question asked is, do you consider your care requirements are fully discussed with you? Again everyone thinks that they are. Care workers are relaxed and informal in how they are. The Assessment emphasises that while there is an overall pattern to each day, things arent rigid. It says that the aim is to create, a warm and friendly atmosphere. For example, someone can have a lie in if they want. We arrived at the Service quite early in the morning when some people were just having their breakfast. Things werent rushed at all. Care workers were taking trays to peoples bedrooms. They didnt just leave them there. Instead, they stopped for a chat about things like the weather and other everyday subjects. Later in the day, we saw people being helped to use the bathroom. They are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are supported to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 12, 13, 14 and 15. There are some interesting things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. EVIDENCE: The plan is that on most weekdays there is a social thing that people can do. These things include outside entertainers coming in to the Service to play music and to things such as armchair exercises. The Manager says that care workers also do things like quizzes and bingo when they have the time. We didnt see any organised activities going on when we were in the Service. Most Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 16 people were sitting in the lounges. There they were watching television or not doing anything in particular. Some people spent time in their bedrooms and again we saw quite a lot of sitting around. We looked at the records of the social things that two people have done over a period of a couple of weeks and there isnt that much to report really. Theres nothing to suggest that social activities are taking place every day or even every few days. Our questionnaire for people who live in the Service asks, are there activities arranged by the home that you can take part in? Only one person says that theyre always are, three say usually and two people say that there sometimes are. The Registered Providers questionnaire asks, what do you think of the quality of the entertainment provided? Two people reply that theyre very happy and seven people say that theyre satisfied with it. One person adds that, Id like to see more. We asked people about this subject and we got different replies. One person says, there are things to do but some people dont want to join in. However, another person says, I pretty much keep myself occupied but sometimes I do get a bit restless. After being busy for much of your life you come in to a home and everythings done for you and there isnt much to fill the time. I suppose more activities could be put on and some people would like to do more. In the feedback we received from care workers, two people comment about this. One says, we dont have time to do social things with people. We do try to sit and talk with some of them after lunch but we dont have time to do quizzes and things like that. The other says, it can be rushed here especially when a shift is one down … because someones off sick and others dont want to do overtime. We think that it would be a good idea for the Manager to take a fresh look at this whole matter. She says that shes going to do this with the first step being asking all of the people who live in the Service what sorts of extra social things they might like to do. Shes going to have this done by 1 July 2009. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, she lets them know if someone is not well or if they are admitted to hospital. The Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids misunderstandings about who has the right to do what. Instead, most people get help from members of their family. People say that they receive good quality meals and that they have enough to eat. People consider meal times to be a relaxed and pleasant affair. One of the questions we ask in our questionnaire for people who live in the Service is, do you like the meals? Three people say that they always do, two people reply Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 17 usually and one person says that they sometimes do. The Registered Providers questionnaire also asks about this. It says, what do you think of the quality of the food? Everyone says that theyre very happy or that theyre satisfied with it. We asked people about this when we were in the Service and we got positive replies. One person sums up the general tone of these when they say, the meals are very good indeed, I always have enough to eat and its nicely presented so you want to eat it. (The chef) is a really good cook and he often asks us how things are and really takes a pride in doing us good food. There is a choice of dish at each meal time. We looked at the records of the meals provided over a two day period. We wanted to see if different people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is reasonable balance, the main lunchtime dishes including things like toad in the hole, chicken and mushroom pie, gammon and cauliflower cheese. We asked care workers about the arrangements for doing snacks and drinks in between meal times. This is important because its a part of normal living. Also, it can be a long time for some people between the late evening milky drink and breakfast the next day. Care workers say that they are quite happy to do drinks and snacks whenever. We looked at the daily diary records to see if things like cups of tea are being made for people at night and they are. The Registered Providers questionnaire asks, what do you think of the refreshments between meals? Again, everyone says that theyre very happy or that theyre satisfied with them. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 16 and 18. There is a complaints procedure. One part of it needs to be changed. The Manager knows how to properly deal with complaints. People are kept safe. EVIDENCE: We asked several people about making complaints. They say and show by their relaxed manner they feel quite okay about raising a complaint should they need to. One person says that, I can say what I want and the staff are always fine about helping me. I havent got anything to complain about really Im quite happy here. In our questionnaire for people who live in the Service we ask, do you know how to make a complaint? Three people say yes and three people say no. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 19 Theres a written complaints procedure. This explains how to go about making a complaint or raising a less formal concern about something. Its best for complaints to get sorted out at a local level. Indeed, the Registered Provider has a duty to do this. However, people also have a right to come to us so that we know what might be concerning them. This is not fully explained in the complaints procedure. The Manager is going to put this right by 1 May 2009. Since our last key inspection, the Registered Provider has looked into three complaints. One concerned an allegation by someone who then lived in the Service about several things. One was that care workers had not been appropriate in their manner towards her. We understand that the Registered Provider assisted the local authority to look into this matter. There was no evidence to support the allegation, but the person chose to move to another residential care service. Another of the complaints concerned an item of lost property that was then quickly found. The other complaint concerned a part of the arrangements that were made for family members immediately after the death of someone who lived in the Service. We understand that the matter was sorted out to the satisfaction of the family concerned. The Registered Provider has a system to where complaints and the steps taken to resolve them are recorded. However, these records werent completed for this latter complaint and so we couldnt examine the matter in detail. The Manager has assured us that a proper record will now be kept of any future complaint. After our last key inspection, we completed an additional random inspection at the Service. This was because concerns had been raised with us about aspects of the way that someone had been supported to manage aspects of their health. In particular, concerns were voiced about how well someone had been helped to take care of their skin. We looked into this and we mainly found things to be in order. We dont have any recent complaints about Charing Court that are outstanding. Its very important that people are confident that they are safe. For example, they need to know that theyre not going to be bullied or pushed around in some way. The Assessment commits the Registered Provider to guarding against this. We asked some care workers about this matter. They know what to look out for. None of them have any concerns about how things are going. One person summarises the general mood when they say, make no mistake about it, the residents come first here and nothing would be allowed that got in the way of their wellbeing. None of the staff would tolerate it at all. The Registered Provider has a written policy and procedure about this matter. The people who live in the Service say and show us that they feel safe in Charing Court. In our questionnaire we ask them, do you know who to speak to if you are not happy? Everyone says that they always do. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 19, 22, 25 and 26. Most of the accommodation is comfortable and pleasant. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. EVIDENCE: On the outside, the building is well maintained. There is a well kept garden at the back and there is a patio area. On the inside, the accommodation is generally well decorated and furnished. Overall, the place has a homely, livedin feeling to it. The bathrooms are neat and clean. Some parts are a bit tatty. For example, in one of the toilets, the floor covering is peeling away and there Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 21 are splits where the ceramic wall tiles join each other. We understand that theres a problem with the sash windows in three of the bedrooms. At the moment these cant be opened. They will need to be sorted out so that the rooms in question dont get too hot once the warmer weather comes. In our questionnaire for people who live in the Service we ask, is the home fresh and clean? everyone says that it always is. One person adds that its excellent and another person says that its perfect. The Registered Providers questionnaire asks, what do you think of the premises. Are they clean, hygienic and free from odours? Everyone says that theyre very happy or that theyre satisfied. The Manager says that work is about to get underway to extend the dining room. At the moment, its a bit too small for everyone to dine in comfort at the same time. As part of the work, the kitchen is also going to be remodelled so that there is more room there too. Another development will see the creation of a proper staff room. At the moment, members of staff are using the conservatory as a staff room. Really, this is part of the living area for people who have made their home in Charing Court and so it shouldnt be used as a staff room. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that when the fire brigade people last looked at the system they said that it continues to meet the national standard. The Registered Provider has a system of doing regular fire safety risk assessments. This is where the Manager and the maintenance man go around the place to check out that everything is still working in the right way. We looked at the records of the most recent one. It says that things are still okay. However, weve asked the Registered Provider to include a particular subject in the next update of the assessment. Weve also asked that the Registered Provider sends the updated assessment to the fire brigade people. This is so that they can have a look at it to check that its detailed enough. The Registered Provider is going to do this as soon as possible and by 1 April 2009 at the latest. The local Department of Environmental Health called to look at the kitchen in 2008. Its report says that, the standard of hygiene is satisfactory. It says that various improvements need to be made. These include cleaning some equipment and reorganising some of the routine checks that are done. We also looked in the kitchen. Its well equipped, clean and well organised. Sensible things are done to ensure good food hygiene. For example, once food is opened it is covered. The temperatures of the fridges and the freezers are checked and recorded to make sure that they are cold enough. The chef knows the importance of making sure that hot foods are checked to make sure that things have fully cooked through. He also knows the importance of good hygiene. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 22 People who need it are helped to get about. One of the baths is special walk in design one. Two more have are fitted with hoists. This means that there is a seat that goes up and down. You can sit on it outside the bath, then it can be raised to go over the side of the bath before its lowered once youre over the bath. There are also mobile hoists. These can be useful if people find it hard to stand. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. When someone moves into the Service, the Manager makes a note of what assistance they need to get about. She looks at things such as the help someone needs in the bedroom and in the bathroom. We asked care workers about this. They know what theyre doing. We saw one person being helped to sit in their armchair in the lounge. They were helped to get up from their wheelchair and they were supported to turn and sit down. They werent rushed at all and the care worker chatted with them so that they knew what to do next. After they were seated, the care worker concerned arranged the persons cushions. This was done so that they were comfortable and settled. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. The accommodation was pleasantly warm, even though it was a cold day outside. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has two commercial washing machines. These have an extra cycle for items that need an especially hot wash. There are also two sluices that are useful for rinsing items off before theyre put in the wash. There are two large dryers. We looked in the laundry. In general its neat and clean. Towards the end of last year there was a major water leak. It was repaired quickly, but it left a large area of damaged plaster behind the washing machines. Shortly after our visit to the Service, the Manager informed us that the work needed to address this damage had been completed. There are new regulations about water purity. These say that things like washing machines and dish washers have to be fitted with special valves. This Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 23 is so that used water cant leak back into the main cold water supply. The Manager isnt sure that the Service meets these regulations. She is going to check this out with the local water supply company. This will be done by 1 June 2009. The laundry manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. When we were in the laundry, we checked some of the garments that were folded up there after having been washed. All of them were marked with a name. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 27, 28, 29 and 30. There are enough care workers around. Care workers know what theyre doing. Some parts of the training arrangements can be strengthened. Security checks are completed on new members of staff. EVIDENCE: The Manager says that there are four care workers and a senior care worker on duty from early in the morning until the night care workers come on duty. There are other people who do nearly all of the catering and who take care of the housekeeping. We looked at the written roster in detail for a period of four recent days. We wanted to see how many care workers were actually on duty. The count is not quite as described by the Manager. On two of the days there was only three Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 25 care workers and a senior on duty during the day. In our questionnaire we ask members of staff, are there enough staff to meet the individual needs of all the people who use the Service? No one replies that there always are, five people say usually and two people say sometimes. One of these latter people then adds that, all the staff try their best, but there are so many people and if they need (help) all at the same time, they do have to wait. Its very important that only honest and trustworthy people are employed as care workers. With this in mind, the Registered Provider completes a number of security checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for one care worker who has been appointed since our last inspection. The necessary checks are all in place. New care workers have introductory training before they work on their own. This entails them having instruction in important health and safety things. They also work alongside more experienced colleagues and generally start to get to know the people who live in the Service. Recently, the Registered Provider has introduced a new work book that new care workers fill out as they go along. We think that this is a very good idea. This is because it helps to double check that nothing gets missed in their introduction to the Service. We asked one care worker about their introductory training. They say that it was very useful. They say that they were introduced to the people who live in the Service and that they were told about each person’s needs for support. Also, they were told about important things. For example, they were introduced to the individual plans of support that weve already told you about. In our questionnaire for staff we ask, did your induction cover everything you needed to know to do the job when you started? Five people answer very well and two people say that it mostly met their needs. This initial training is just to get them started. Theres a lot to learn after that. The Manager says that all care workers are expected to do regular training in important subjects. For example, in how to safely support people move about, in food hygiene, in keeping people safe from harm and in basic first aid. Some of this training is done in-house and some of it entails going out to courses. We looked at the records of the training that two care workers have done. Theyve done quite a lot of relevant courses. However, there are also quite a few gaps where courses seem to have missed. Also, theres no real plan to sort out these oversights. The Manager says that she is going to review the skills and knowledge that each care worker has. This is so that arrangements can be made for each care worker to have training in the future that will be of the most benefit for them. This is quite a big bit of work to do. The Manager hopes to have it done within about a year. There is a total of 17 care workers and senior care workers. Of this number ten have either completed a National Vocational Qualification in health and personal care or they are on with doing it. This qualification is a very good Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 26 idea. This is because it helps care workers to deliver high quality residential care services. In our questionnaire for staff we ask, are you being given training which is relevant to your role and which keeps you up to date with new ways of working? Everyone says that yes they are. One person adds, every individual needs totally different care, so its up to us to communicate and teach each other how to help each person. We spoke with three care workers to find out what they know about particular bits of the support they will need to give people. They know a lot about how each of the people who live in the Service like to be supported. For example, they know about helping older people to take care of their skin. They also know about how people sometimes express themselves in an indirect way by what they do rather than by what they say. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 31, 33, 35 and 38. Things are well managed. People are asked what they think of the Service, but parts of this process need to be a bit more organised. People are helped to buy what they want. There are sensible health and safety things. EVIDENCE: Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 28 The Manager has the equivalent of both of the formal qualifications that are recommended by the Standards. These qualifications are important. This is because they’re designed to help managers ensure that high quality support is reliably provided. The Manager recognises that its really important to have good team work in the Service. She says that this is supported in several ways. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. There are team meetings every few months so. We looked at the records of the last one of these. We wanted to see what sorts of things are being discussed. Theyre practical and relevant. For example, the members of staff talked about the importance of making sure that the accommodation is kept tidy and clean. In our questionnaire for staff we ask, do the ways you pass information about people who use the Service between staff (including the manager) work well? Three people answer always, three people say usually and one person says sometimes. We also ask, does the manager meet with you to give you support and discuss how you are working? Three people say that she regularly does, one person says often, two say sometimes and one says never. Its really important that the people who live in the Service have a direct say on how things are going. After all, theyre the experts. because they live there. The Assessment says that the people who live in the Service are asked their views as part of every day life. They are also involved in the reviews of their plans of support. In addition to this, there are the questionnaires that weve been quoting from in our report. All in all, theres a lot of useful things being done to find out what people think. However, we think that more still can be done. Last time the questionnaires were sent out only 10 people who live in the Service chose to reply. This is a disappointingly low number. It might be possible to support more people to take part in future so that the Registered Provider can find out what their views are. At the moment, theres no clear system to tell people what has been said in the questionnaires and about what is going to be done by the Registered Provider to act on any improvements that may have been suggested. Also, there are no house meetings when people who live in the Service can get together and have a chat about how things are going in their home. These are all things that can be introduced to strengthen the quality assurance system in the Service. Earlier on weve mentioned the Assessment. This is a document that should give us a really detailed review of how things are going in the Service. Were a bit disappointed to note that most of the sections arent completed in that much detail. Indeed, some of the sections havent been completed at all. In future, well need the Assessment to be much thorough. The Registered Provider helps some of the people to pay for everyday things. For example, if they if they want to see the visiting hairdresser or if they want Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 29 to buy some toiletries. The Manager adds up what shes spent and then sends a bill every now and then to the relatives. Each person and their relatives have agreed to this in advance. We checked out some of the records. We wanted to see if theres a receipt for items said to have been bought. Also, we checked that the sums add up. Things are in order. One person has some of their cash held by the Manager. This is then used to buy things for them. Again, we checked the records of the various transactions involved. Again, we found everything to be okay. The Manager says that regular checks are completed to ensure that the Service’s fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. However, some of the records of the checks that have been done are not up to date. The Manager says that this oversight will be corrected without delay. More detailed checks are completed every now and then by an engineer. There are regular fire drills. The Manager says that in addition to this, all members of staff are expected to attend a fire safety course once each year. This training is more detailed than the things that are done in a fire drill. We looked at the records of who has done this training. There are quite a few gaps and some people are significantly overdue to have this training. The Manager is now going to strengthen the present arrangement. In future every member of staff will be asked to show that they understand key parts of the fire safety procedure at least once every six months. The Manager says that everyone will have been included in this new system by 1 May 2009. In the interim, we asked two care workers about bits of the Services fire safety procedure. They know about it. There is an up to date report from an engineer about the gas appliances that says that they are in good working order. There is also a report by an electrician about the Services electrical installation. This was done in 2007. It says that the installation is basically sound but that it needs some improvements to be made. We checked four of these to see whats been done. One was about the need to replace a burnt out power socket in the kitchen. This has been done. The other three involve the need to replace ordinary wall light switches in toilets with pull chord switches. These items havent been done. The Manager says that all of the outstanding matters should be sorted out within about six months. We looked at the record of accidents that have occurred in the Service since the beginning of the year. There hasnt been that many. Most have been minor bumps and bruises. The Manager keeps an eye on who has had an accident and what has happened. This is done so that she can do something if there is a particular problem that is causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. The Manager says that she and the maintenance man regularly check the building to make sure that there isnt anything that might result in someone having accident. Theyre looking for things like frayed carpets that might cause Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 30 someone to trip over, or something sharp that can catch you when you walk by. The Manager says that they havent found anything that needs attention. We kept our eyes open when we were walking around. We didnt see anything either. Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X 3 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 32 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Charing Court DS0000043997.V374317.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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