Care Home: Charter House

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• The Lodge Nursing Home
• Bracken House
• Sunnycroft
• Field Farm House
• Edgeview Nursing Home
• Church Terrace Nursing & Residential Home
• The Forbury

What the care home does well People remain satisfied with the service they receive. Prior to the inspection, in surveys, one person described what the home does well as ‘helps me to live as independently as I can’. Another person wrote ‘I like the food, the house is always clean and the staff treat me well’. During the inspection one person told us that what he likes about the service is ‘“Nice food, nice room, nice staff”. Another person said ‘it’s lovely living here’. Health professionals who have contact with the service are equally as satisfied with two indicating maximum satisfaction about the standard of service provided. They told us that ‘care has been consistently of a high standard’ and that what the service does well is ‘appreciates the views of the residents’. Our inspection validated the information we had been given. Two people have and are being supported to move out into more independent living, people enjoy their meals and continue to be satisfied with how staff treat them. People’s mental and physical health needs are also supported well with appointments attended and the results of appointments followed up. What has improved since the last inspection? Since the last inspection a new manager has been appointed and has been successfully registered with us. The new manager has been in post for 6 months and so it is early days but we are hopeful that this will provide the service with better management continuity and accountability. The new manager has ensured that people know how to complain and has worked hard to improve medication management systems to reduce associated risks. For example, staff now check with the pharmacist that it is safe to administer medications bought over the counter in case they react with prescribed medications that people are taking. Menus have been reviewed and improved and people are happy with the quality and quantity of meals provided.Charter HouseDS0000020543.V377406.R01.S.docVersion 5.2 What the care home could do better: Care plans and risk assessments are in place and are reviewed regularly. However, when people’s needs change it is important that this is reflected in care planning and risk assessments so up to date guidance is available for staff. We found that this had not been done to reflect medical advice given following an accident sustained by one person living there. In addition, this accident is an incident which should have been notified to us to help us to monitor people’s safety and the quality of care. Following a previous failure to notify us, we formally required the service to improve the way they notify us and we found this requirement to have been breached. At the time of the incident the registered manager had not been appointed to post, but the provider had a responsibility to ensure that we were notified and did not do so. We issued a Code B notice at inspection and took evidence under the Police and Criminal Evidence Act of the failure to meet regulation 37. At the last inspection we found gaps in Criminal Record Bureau checks for new staff. This has improved at this inspection and new staff have not started until these significant checks had been carried out. There are weaknesses in how the service obtains references however, and the manager must ensure that the home’s response is more robust. Although we found people’s experiences to be positive, currently management monitoring systems are lacking and as such concerns or changes in service quality and satisfaction may not be identified and acted on. Also, the service is not setting and evaluating goals to ensure service development. Therefore there is a lack of focus and drive to improve weaker areas of the service. Last year’s plans to improve the environment for example have not materialised and the reasoning behind this is unclear. Enough is not being done at the moment to assure us of the home’s potential to improve. People we spoke to have confidence in the new manager but she will need ongoing support and resources to implement the required changes. Key inspection report CARE HOME ADULTS 18-65 Charter House 15 Queens Road Donnington Telford Shropshire TF2 8DB Lead Inspector Deborah Sharman Key Unannounced Inspection 1st September 2009 09:30 Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charter House Address 15 Queens Road Donnington Telford Shropshire TF2 8DB 01952 676 865 01952 401 986 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) Mrs Sukjit Kaur Kang Christine Elizabeth Turner Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Mental disorder, excluding learning disability or dementia (MD) 8 The maximum number of service users who can be accommodated is: 8 10th September 2008 Date of last inspection Brief Description of the Service: Charter House is a care home providing accommodation and personal care for up to eight people with difficulties with mental health. It is privately owned and is a detached property situated in a residential estate in Donnington, Telford. All bedrooms are single occupancy none of which have an en suite facility. The communal areas are homely and domestic in character. The property is undergoing a refurbishment and redecoration programme. The weekly fee is not stated in the Service User Guide. Therefore enquiries about the fee should be directed to Charter House. Charter House DS0000020543.V377406.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 1 star. This means the people who use this service experience adequate quality outcomes. One Inspector carried out this unannounced key inspection on 1 September 2009 from 9.30am to 6.15pm. No one knew we were going and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by us as key. These are the National Standards which significantly affect the experiences of care for people living at the home. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection we were provided with written information and data about the home in an annual return which is called an AQAA. We had sent surveys to people who live and work at Charter House and also to independent health professionals who have contact with the home. We received completed surveys back from 5 people who live at the home. We received completed surveys from 2 staff members and 3 independent health professionals. Their comments helped us to plan our inspection and have helped us to form a judgement about the quality of support provided. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. An Expert by Experience (in this report known as ‘the Expert’) assisted the Inspector. This was someone with personal experience of using mental health services who had been trained to accompany inspectors during a visit to a service. Experts by Experience observe what happens in the home and talk to service users to get their view of the home. This Expert talked with four people living at Charter House (a fifth person declined) and provided a report of her findings, parts of which have been included in this report. The new registered manager and deputy manager were available to answer questions and support the inspection process. We had the opportunity to talk to the parents of one person who were visiting. We looked at how two people are supported in detail using care documentation and by talking to them. We read a variety of other documentation related to the management of the care home such as training, recruitment, accidents and complaints. We toured the premises to see how it meets the needs of the people whose care we looked at. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 6 All this information helped to determine a judgement about the quality of care the home provides. What the service does well: What has improved since the last inspection? Since the last inspection a new manager has been appointed and has been successfully registered with us. The new manager has been in post for 6 months and so it is early days but we are hopeful that this will provide the service with better management continuity and accountability. The new manager has ensured that people know how to complain and has worked hard to improve medication management systems to reduce associated risks. For example, staff now check with the pharmacist that it is safe to administer medications bought over the counter in case they react with prescribed medications that people are taking. Menus have been reviewed and improved and people are happy with the quality and quantity of meals provided. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No one new has moved in so we have not been able to make a judgement about their experience of this but information about people’s rights and responsibilities is not sufficiently available. EVIDENCE: At the time of the inspection, six people were accommodated. One person had been permanently discharged and this room is vacant. A second person has moved to another service for a trial and in the meantime the room is being held open for six weeks. Since we last inspected no one new has moved in. We were therefore not able to assess on this occasion, how the home supports people with the decision to move in. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 10 We looked at brochures that are available to help new residents decide whether the service could meet their needs and can see that a copy has been given to everyone who currently lives there. This helps them to know about their rights and responsibilities and action they can take in the event of a concern. This documentation does not include specific enough information about fees charged to stay at home and how these are paid. We talked to people who currently live there and they were not aware of whether they had been issued contracts. They told us they do not understand the fee structure but that this does not worry them. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are satisfied that their needs are met, that they are listened to and can make choices about their day to day lives. There are few accidents but systems to support care and risk management could improve to ensure that all staff are aware what is required of them when people’s needs change. EVIDENCE: We talked to most people living at Charter House. Using records and discussion we looked in detail at the care provided to two people living there. We were also able to talk to one person’s parents who were visiting on the day we inspected. We saw one person was wearing traditional dress and we were told how much a resident appreciated staff support following bereavement this Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 12 year. All the information available to us, tells us that people are satisfied with the care that they receive and feel that their needs are fully met. We spoke to staff who are satisfied that care plans and risk assessments provide them with the information they need about how to care for people. Staff also described to us how an effective handover when they come on duty helps them to know about and respond to any changes in peoples need or health. We looked at peoples written care plans and risk assessments. We could see that these are regularly reviewed and this is good practice. However care plans are not in place for all significant need and we could see that written guidance had not been provided when someones need had temporarily changed following an accident. It is important that new care plans and risk assessments are put in place when needs change or new needs arise to ensure that all staff have access to up-to-date and correct information about how to provide care and limit risk. We could not see that this had affected the person adversely and so are satisfied that people’s needs are met. People told our expert by experience that they are satisfied that they can do what they want when they want to and that their rights to make choices about their lives are respected and supported. This confirmed information we had received in surveys prior to the inspection where four people said that they can always make decisions about what they do each day and two people said they can usually make decisions about what they do each day. The home is making efforts to listen to and respond to peoples choices. A suggestion box is a new development that has been put in place to support this. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s independence is promoted. They can opt in or out of activities as they wish to and they enjoy their meals. People would benefit further if all activities provided reflect people’s individual aspirations. EVIDENCE: This year we were able to evidence progress with helping people to move on with their lives. In a survey one person who told us what the home does well, wrote ‘they help me to live as independently as much as I can’. On arrival, we found the home to be under occupied because two people have made positive choices and have been supported to move out, although one at the time of writing is on a trial basis. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 14 Everyone that we spoke to is satisfied with their lifestyle and feels that they are as occupied as they want to be although one person told us he is looking forward to starting college but continues to say he would like to be supported to attend football matches and therefore this is unmet from a previous inspection. Those people who are less active and access the community less than others, told us that this is their preference and they are offered opportunities. Three people who wanted to go have enjoyed a holiday this year. The home surveyed people in March 2009 and found that people are largely satisfied with the quality of the meals. Two people in our more recent surveys told us that meals are what the home does well. From talking to people, we can see that people continue to be satisfied. They are able to do food shopping, cook and influence the menus, which in response to people’s suggestions have been changed and improved. Records of meals provided show us that a variety of hot meals are provided daily. The manager confirmed that meals are cooked fresh from scratch. We also observed people to be having breakfast at different times to suit their particular preference and routine. Where there are concerns about people’s weight, this is monitored monthly and medical advice is sought. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s physical and mental health needs are supported well. This means that known conditions are treated and changes in health are identified and treated. People receive their medication as it is prescribed to ensure that they continue to feel well. EVIDENCE: Prior to inspection, in a survey a staff member told us that in their opinion what the home does well, is meets people’s health needs. We have also received very positive feedback from independent health professionals with two of them indicating maximum levels of satisfaction about how the home Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 16 manages people’s health. One medical professional who has regular contact with most of the people who live at Charter House told us that ‘care has been consistently of a high standard’. Nobody felt they needed to make any suggestions about how the home could improve the way it helps people to manage their physical and mental health needs. They are satisfied that the care service always seeks an acts on advice to meet people social and health care needs, always responds to the diverse needs of people and always responds appropriately if a concern is raised. Discussions with people and perusal of health records on the day of inspection assured us that people attend their health appointments and that issues raised are followed through. People who need them have regular blood tests to ensure their medication doses can be accurately prescribed. Staff are quick to follow up the results of medical tests to ensure changes in health are known and can be responded to. People are also supported to attend routine health screening with the dentist and optician for example. A number of things have been done to improve how medication is managed since we last inspected. Staff now seek and record advice from the pharmacist when people want to take over the counter medication to ensure this doesn’t react with the person’s prescribed medication. Steps have also been taken to ensure that the home improves medication safety when people take medication with them when they stay away from the home. In addition it is positive to see that although all staff have completed medication training that the manager is now carrying out assessments of their continued competence to administer medication safely. We looked at how two people are receiving their medication and identified no concerns. This gives assurance that people are receiving their medication as it is prescribed which benefits their health and welfare. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to complain should they need to and feel that they would be listened to. People also feel safe and systems are generally in place to ensure that they are protected from abuse and harm. EVIDENCE: Since we last inspected, the new registered manager has taken steps to ensure that everyone knows how to make a complaint should they need to. Everybody who provided us with information both before and during the inspection have told us that staff treat them well, that they feel safe and know how to make a complaint and who to talk to if they are unhappy. There have not been any complaints made since last inspection, although a matter that we identified at the last inspection was investigated by social services and was not upheld. We could see that the outcomes of this had been recorded demonstrating that concerns and complaints are openly managed and accounted for. Since then there have been no complaints, no allegations, no disciplinary action, no physical restraints and only one accident. The three health professionals who provided us with feedback are all happy that the service responds appropriately to any concerns that they may raise with them. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 18 The new registered manager has taken steps to clarify her understanding of safeguarding procedures. This has included attending recent safeguarding training and a further course is booked to help her to understand her new safeguarding responsibilities as a manager. Four out of five staff have attended safeguarding training. We talked to one staff member about abuse and protection matters. She was able to describe to a very high standard what abuse is and what her role is should she become concerned about the safety and well-being of a vulnerable person. We have advised the registered manager to ensure that abuse and protection issues are regularly discussed in staff meetings and in residents meetings to ensure that people continue to know what is acceptable and unacceptable behaviour and that they all know what to do about it in the event of any concern. We looked at how people’s money is managed. Where people are able to they manage their money independently. When people need support, the home provides this and systems are in place to safeguard people’s money. We could see that staff check people’s money daily and that any financial activity is signed for by the person whose money it is and in addition by two staff. Receipts are not retained by the service as people keep their own receipts and change. Given the level of people’s independence, managers did not feel it was appropriate for them to intervene further. One person indicated a shortage of money. We could see that his financial affairs are now managed by the Local Authority who delivers money to the home monthly for him. Records showed us he had been without any money for a week but that a delivery was imminently due. Relatives told us that the home never sees their daughter go short of money and they were pleased about this. One person described being anxious about his possessions as he had heard that another person had lost money from a bedroom. The person who had lost the money has a key but doesn’t use it and didn’t want the matter taking any further and the matter was not pursued by managers. The person who is anxious about his possessions doesn’t have a key as he had understood that he needs to pay a deposit and he didn’t feel able to pay this. We discussed this with managers who said this is not the case and we asked them to ensure that this is clear. We advised that the home starts to maintain inventories of people’s possessions. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is insufficient investment in the maintenance and improvement of the premises. Some parts of the accommodation are homely and comfortable but other parts continue to deteriorate, and may prevent people from enjoying their home to full effect. EVIDENCE: People who live at Charterhouse are all fully mobile, their physical needs have not changed and the layout of the premises continues to meet their needs. However, we again found a lack of improvement to the environment. Plans that we were assured of at the last inspection have not been carried out and externally the facilities are poor. When we arrived at the front of the premises Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 20 we could see that there had been no improvements. For example, plastic sheeting still covers a portion of land at the front, large weeds were seen to be growing through the hard standing near to the front door and a window at the front of the property is rotten. The rear gardens continue to be unusable with long grass and weeds. Windows were dirty but the registered manager said that the window cleaner was due. Inside, the facilities are sufficiently clean and there is no Malodour but in parts the finish is poor and in need of repair and replacement. The flush on the downstairs toilet was broken and in the 12 months since our recommendation, a window covering to ensure comfort and privacy has not been provided in the first-floor bathroom. We were not provided with an acceptable explanation for the lack of progress and development and this does not reflect well on the management of the home. Communal living areas however, where people relax are provided to a better standard and are comfortable and homely. People have not raised concerns about the standard of the premises and continue to be satisfied with their personal space, their bedrooms. It is important however, that steps are taken to prevent further deterioration to ensure the premises continue to be fit for purpose. We were pleased to see that all toilets are now adequately supplied with soap, paper towels and toilet paper and that a system is in place to ensure that stocks are replenished daily. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by motivated and sufficiently trained staff who they trust and respect. Significant checks are being better carried out prior to employing new staff but a more robust approach to seeking references is required in order to identify any employment issues which may be detrimental to vulnerable people. EVIDENCE: Before we inspected, 5 people living at Charterhouse had told us in writing that all staff and managers always treat them well. This was confirmed during the inspection by talking to the people who live there, talking to visitors and observing staff interaction with people. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 22 Before we inspected, in completed surveys two staff told us that their induction prepared them very well for the job and that they are both fully satisfied with the training provided to them. They stated that they have enough supervision and support and feel that the ways in which they share information within the service works well. Again, talking to staff on the day of inspection and looking at records shows us that staff are enjoying their work and are sufficiently trained and supported. Eighty percent of workers are qualified to the national expected level. Visitors spoke highly of staff describing them as friendly, welcoming and good at communicating with them. The new registered manager has improved the administration of training records. Individual training profiles are now in place for each staff member and will help the manager to identify further training needs. It is positive too that the manager is spending time with each staff member to identify and meet peoples personal training needs. We could see for example, that staff are being individually tutored about record keeping, confidentiality and the Data Protection Act. At the last inspection we had concerns that not all staff were being recruited safely. References were being obtained but significant checks such as the criminal records bureau check and POVA first check which tells employers whether applicants are suitable to work with vulnerable people were not always being obtained in time. At this inspection we looked at how two new staff had been recruited. On this occasion, the Criminal Records Bureau and POVA first check had been obtained in time but there needs to be a more robust approach to seeking references. Where applicants have previously worked in the care industry, it is important that a reference is sought from them in addition to a more recent employer. Where there is a conflict of interests such as the most recent employer being a relative, an alternative reference should be sought. Managers should seek to authenticate and evidence the authenticity of references by writing to request references and retaining this request on file. We found that referees are not always dating the reference at the point of writing. As the home is not noting the date that the reference is received, these two omissions do not demonstrate that references were obtained prior to the person starting in employment. We were able to talk to a new staff member who confirmed that she had been fully supervised during a long and extended induction period until she felt sufficiently confident to take responsibility for supervising and supporting people who live there. The home is currently fully staffed and is not using bank or agency staff and this helps the service to provide continuity of care. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live and work at the service along with people who liaise with and visit the service are satisfied that the service is managed in the best interests of people who receive care and accommodation there and this reflects well on how the home is managed on a day to day basis. Management systems are not sufficiently developed yet however, to fully meet regulatory responsibilities and there is insufficient investment in the service to help it to improve and develop. EVIDENCE: Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 24 Since the last inspection, a new manager has been appointed and has in the last six months been successfully registered with us. This is a positive development to ensure that a responsible manager is more available than was previously possible. During the registration process, we made some recommendations to support the new managers development and it is positive that these have been acted on. She has almost completed an appropriate national qualification to prepare her for the role of registered care manager, is being supported to gain knowledge about financial systems and has attended safeguarding training. The AQAA says, we aim for a management approach which creates an open, positive and welcoming atmosphere for both staff and service users. We experienced this and visitors that we spoke to also confirmed this as their experience. The AQAA also states that ‘the welfare and safety of our staff and our service users are promoted and protected as far as is reasonably practicable.’ Without doubt, we have verified that the care and support provided is good and people’s needs are being met. We could also see that a range of systems are in place to support people’s welfare and safety. We sampled a number of maintenance certificates to ensure that equipment and facilities are serviced regularly and are as safe as possible. All that we requested were available and up to date. Hot and cold food temperatures are monitored and are safely maintained to avoid the risk of food borne illness and water temperatures are checked very regularly to avoid the risk of burns and scalds. The new manager has implemented a number of improvements to the management of medication administration and the implementation of medication competency audits is a new and positive management tool to ensure people’s safety and welfare. The new manager is also improving training records so that staff training can be monitored more easily. The proactive management of people’s health and the positive experiences that people have of their care reflects well on how the service is managed. Conversely, there are omissions in management and we are not fully satisifed that systems are sufficiently in place yet to make the necessary improvements. The quality assurance tool continues to be reviewed but is not at a stage when it can be used to help the service to fully assess its own performance. Although we were told that the provider visits regularly, there was no evidence that these visits are used to to formally monitor standards as no records were available. Sustained lack of progress in making improvements to the environment and to ensure aspects of the environment are maintained to an acceptable level do not provide assurance of good overall management, that has the ability to set and meet goals and targets. This is demonstrated further by the provider’s failure to renew the company insurance leaving the service uninsured for a 2 month period between June and August 2009, which Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 25 was only corrected when the insurer brought this to our attention. In addition, the service failed to notify us, contrary to regulation, of an incident affecting the welfare of a service user. As there have been previous omissions, we required the service at the last inspection to improve this. The new registered manager was not the manager at the time of the incident, but irrespective of this, systems should have been in place to ensure that the service met its regulatory responsibility. At the beginning of this inspection we were informed that there had not been any accidents, notifiable incidents, hospitalisations or treatments but later we found from perusal of accident records that an accident had resulted in a fractured bone and several trips to hospital for treatment. We should have been notified of this. We took evidence of this breach in regulation and are considering any future action. It is important that the service informs us of any incidents because this helps us to monitor the service and affects our decisions about when to inspect to ensure that people are safe and well cared for. We have advised the new manager to ensure that all staff are aware of the need to report matters defined under regulation 37, so that appropriate action can be taken to report appropriately without delay in future. We can see that the new manager is working hard, is well regarded and is keen to make improvements. It is important that she receives the support of the provider to set and achieve goals, and this will require the allocation of time and resources. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 X 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 1 X X 2 X Version 5.2 Page 27 Charter House DS0000020543.V377406.R01.S.doc Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA18 Regulation 12(4)(a) Requirement Suitable arrangements should be made to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. This includes (but may not be restricted to) the provision of blinds or curtains in the bathroom. New recommendation September 2008. Window covering not met September 2009. 2 YA34 19(4)(c) The registered person shall not allow a person to work at the care home unless the employer can demonstrate the authenticity of written references provided in respect of that person. The registered person must demonstrate that references are obtained prior to the start date of new employees. The registered person must always ensure that references Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 28 Timescale for action 01/12/09 01/09/09 are always sought from the persons last care employer in addition to most recent employer where these are different. The registered person must seek additional references where there may be a conflict of interests ie where the former employer / referee may be a relative of the applicant. New Requirement September 2009. Visits by the provider must take 01/12/09 place monthly in accordance with regulation 26, these visits must be recorded and must be available for inspection. New Requirement September 2009. The Registered person must give notice to CQC without delay of the occurrence of any incident as defined in Regulation 37 1(a) to 1(g) and any notification given orally must be confirmed in writing. New requirement arising from random inspection 12.2.07. No notifiable incidents by September 2007. Not met at inspection September 2008. Not met at Inspection September 2009. Code B issued and evidence taken. 3 YA39 26 4. YA41 37 01/09/09 Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA14 Good Practice Recommendations All service users should be supported to pursue their own interests and hobbies. Plans should be in place for example to support attendance at football matches through effective budgeting and the flexible provision of staff. New recommendation arising from inspection September 2007. Not met September 2008. Not met September 2009. 2 YA23 Written inventories of people’s possessions should be prepared, monitored and reviewed to help assure people that their possessions are safeguarded and can be accounted for. New Recommendation September 2009. External grounds should be appropriately maintained. New recommendation arising from this inspection September 2007. Not met at inspection September 2008. Not met at inspection September 2009. 4. YA1 The Statement of Purpose and Service User Guide should be reviewed and should include the weekly fee. These should be made available to all service users and to new service users pre admission. Ways of evidencing the provision of these regulated documents should be considered. New recommendation September 2008. Not met September 2009. 5. YA5 A contract outlining the terms and conditions of residence should always be provided to people living at Charter House at the point of admission. 3. YA28 Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 30 New recommendation September 2008. Not met September 2009. 6. YA6 Guidance should be available in care plans and risk assessments for all significant needs and risks to help staff know how to meet needs and limit risks to service users. New recommendation September 2008. Not met September 2009. 7. YA39 The home should develop and maintain an effective quality assurance and monitoring system. This requirement is part met at inspection 12.2.07. Target date set for 31.5.07 and at September 2007 remains part met. No progress at this inspection September 2008. Not met September 2009. Charter House DS0000020543.V377406.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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