Care Home: Chaseborough House

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What the care home does well The home continues to update and maintain the decoration of the home and upgrade the environment for the comfort of the people who live at the home taken into consideration. People are offered a choice of food to suit individual tastes and all food served is freshly prepared. Many of the people living at the home said the care and support provided by the home was very good. Observation throughout the inspection showed the staff to be being kind gentle and very caring towards people living in the home. The home benefits from having a long serving staff team to promote continuity in care. What has improved since the last inspection? General maintenance and updates have been maintained by the owners. The home has fitted a new kitchen since the last inspection. What the care home could do better: All controlled drugs must be held in accordance with the Controlled Drug legislation to protect people. All staff files should hold all recruitment information so only suitable staff are employed. All new staff would benefit from a formal Induction programme. Key inspection report Care homes for older people Name: Address: Chaseborough House Village Hall Lane Wimborne Dorset BH21 6SG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kim Fowler     Date: 2 4 0 8 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 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 Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Chaseborough House Village Hall Lane Wimborne Dorset BH21 6SG 01202822908 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: chaseborough@scottie.org Mrs Sally Ann Marshall care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Chaseborough House is a care home accommodating a maximum of 16 older people. The home is situated in a rural setting between Verwood and West Moors at Three Legged Cross, with local amenities including a pub, shops and village hall available within a short level walk. Accommodation is offered on the ground and first floor. The communal lounge and dining room are on the ground floor. A passenger lift operates to the first floor. There are twelve single rooms and two rooms registered doubles. All but one room has en-suite facilities, including seven rooms with baths, WC, and hand basins. The current fees for the home are 450 pounds to 465 pounds but may vary dependent on individual needs. Additional charges include hairdressing, chiropody and newspapers. 0 Over 65 16 Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and took place between 9:20am and 2:20pm on 24th August 2009. The Registered Provider, Mrs. Sally Marshall assisted throughout the inspection. The inspector made a tour of the building and spoke to most of the people living at the home and the staff on duty at the time of the inspection. Documentation relating to the care planning process and the management of the home were examined. Any comments are in the relevant section of the report. Care Homes for Older People Page 5 of 25 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 6 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 7 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering admission to this home can be confident that an assessment with be completed before admission to ensure the home can meet their individual needs. Evidence: The files examined for people living at home show that the one new admission and other files had a completed pre-admission assessment carried out and that people admitted to the home have been assessed. Another file examined showed the placing authorities care plan supports these assessments. This ensured that the care staff were aware of peoples needs. Several staff members were spoken with during the inspection and were fully aware of the needs of each persons currently living at the home. Including one person recently admitted who required additional support with medication. Care Homes for Older People Page 8 of 25 Evidence: One person living at the home was spoken to and confirmed that they had visited the home before they were admitted. Another person thought there relative had visited the home for them before being admitted. The homes AQAA returned to the Commission states, We have improved our preassessment forms and subsequently care plans so that we are better able to cope with the service users needs from day 1. Chaseborough House residential Home does not provide Intermediate care. Care Homes for Older People Page 9 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home receive consistent health and personal care as appropriate The homes practices relating to controlled medication administration and storage could place people living at the home at risk. Evidence: Four files were examined during this inspection and three were found to hold completed care plans holding comprehensive details in place. Each file examined of people living at the home contained an individual care plan based on care needs and how the home would meet these needs. The daily care plans are easy assessable for staff on duty and risk assessments are held on individual files for the protection of all people living at the home. These care plans give detailed instructions to all staff as well as information to new staff to ensure intimate personal care is being provided in a manner that meets with the approval of people receiving the care. This is particularly important where people Care Homes for Older People Page 10 of 25 Evidence: are unable to express themselves verbally. The fourth file did not hold a care plan completed by the home, however this file did hold a care plan from the placing authority. The owner, Mrs Marshall, stated that the home were currently writing this persons care plan but still required additional information on how best to manage this person diabetes. The home did have in place clear guidelines drawn up with the support of family members on how best to manage this person diabetes including how to administer the insulin and other signs and symptoms affecting the well being of this individual. Mrs Marshall has the support of the District Nurses team to assist with training and monitoring this persons health care support. One family member spoken with confirmed that the home had asked for information on how best to manage one person health care needs. Evidence was recorded into individual files that people living at the home are referred to the District Nurse team when needed. Recorded onto an individual care plan was that a District Nurse was due to visit several people living in the home and continue to support staff and these people with their changing health care needs. All people living at the home have access to all health care services and this information was recorded into individual files examined. These files recorded that there was input from other professionals including GPs, chiropodist and consultants based at the local hospital. One District Nurse was spoken with during this inspection and confirmed that they visit the home regularly and the home will contact them for advice when needed. The nurse also stated that the staff in the home carries out any treatments required between their visits and all treatments are carried out in private. The medication is kept in a fixed lockable cupboard, and there is a separate fixed lockable box for any controlled medication held. The medication system was examined and showed that the home uses the blister pack system to dispense medication and staff were observed administering medication. One staff member was observed dispensing medication at lunchtime, this staff member was able to confirm they had received medicating training from a local pharmacist. Care Homes for Older People Page 11 of 25 Evidence: The home current holds one controlled drug medication, however this was not held in accordance with the Controlled Drug regulations. Mrs Marshall agreed to place this drug in the controlled drug cupboard and was observed recording this drug into the controlled drug register. The inspector spoke to most people living at the home and some were able to comment directly about their experiences of living at the home. Most were able to clearly state that they were well cared for and that their dignity and privacy was maintained. The inspector observed people who were confused being treated respectfully by the care staff, staff knocking on bedroom doors and staff assisting people with meals. Several people said they were assisted promptly. It was observed that people who chose to wander freely through the home were able to. One person said, The staff are wonderful. From discussion with Mrs. Marshall it was clear that the home will provide additional support including extra staff, specialist support from McMillan nurses and any specialist equipment needed to ensure people are able to stay in the home for as long as possible and in a recent case until the death of one person. The home had received a letter from family members thanking the staff for all the care and support offered to this person. The owner and the staff are to be commended on the care they offered this person when they became terminally ill. The homes AQAA returned under what we have improved over the last 12 months states, We have greatly improved our medication systems. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals and mealtimes are not rushed making them an enjoyable, social occasion for people. The home welcomes and encourages families and friends to visit. Evidence: People were observed moving freely around the home. One person remained in their room and was asked said, I like to stay here. The staff were seen interacting with people and discussing everyday topics and included assisting individuals when needed showing staff were aware of the needs of people living in the home. Displayed in the homes main entrance was a notice showing this month activities and visiting entertainment professionals. This included a planned boat trip and a music and movement session due. Mrs Marshall, Registered Provider, also stated that either she or the staff team carries out activities when possible. Some of the people spoken with were able to confirm that activities are available and offered, though one person stated they choose not to participate. Activities mention included, quiz, Bingo and watching a film. Care Homes for Older People Page 13 of 25 Evidence: Several people walk to the local shops and other trips are arranged with the local Age Concern club. Visitors are welcome at any reasonable time and can visit their friend/family in the privacy of their own room. One visiting relative was spoken with during this inspection and was able to confirm they were able to visit at any reasonable time. Also this visitor confirmed that they were able to see their relative in private if they wised. One person said, I see my son. The homes AQAA records that, We have provided more activities over the last 12 months. Some people spoken with stated that the staff helped them maintain their independence as much as possible and are able to make everyday choices in their daily lives. One person was observed getting up at their preferred time, early afternoon, and offered a meal of their choice. This person will ring for assistance when they wish to get up. One person is currently living in a near by Sheltered Housing development and is being assessed for a permanent placement there to live more independently. All bedrooms visited contained personal possessions and items and several people living at the home said that the home encouraged them to bring in items from home. All people who were able to made positive comments about the food provided. The staff member on duty who was cooking the meal confirmed that the home has all the required fresh ingredients needs and has 4 weekly menus available and displayed for all to see and this showed a varied and nutritional diet. It was evident from the food seen served at lunch time on the day, Sausage casserole, mash potatoes and fresh vegetables followed by a choice of strawberry mouse or fresh fruit and cream that the food was home cooked using fresh products. The meal was well presented and freshly prepared. Staff were observed serving meals individually and asking each person in turn what they would like and how much. The staff confirmed that the evening meal offered to people is always a personal choice for individuals. During discussion with people about food they said it was excellent and another said, to much of it!. One person was able to confirm that they were able to choose a different meal if they did not like the one on offer. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Chaseborough and their relatives can be confident that any issues of concern or complaints would be taken seriously and dealt with promptly. Evidence: The home has a copy of the complaints procedure in the main entrance accessible to people living in the home and any visitors. Mrs Marshall lives on site and is available most days and felt that any concerns raised would be dealt with immediately. The homes has a designated complaints file and also contains letters and cards from appreciative families and friends. The home has not received any complaints and neither had the Commission. People spoken with stated that Mrs Marshall was available and they were able to discuss any worries with her directly. One person confirmed that any issues raised would be dealt with promptly and without fuss. The home does hold a book for any minor concerns raised and this included the action and outcome for each issue raised. However some of the information recorded was personal information and was not covered by the Data Protection Act. All personal information on people living in the home should have a separate record for each issue raised. Care Homes for Older People Page 15 of 25 Evidence: Mrs Marshall confirmed that most staff has completed the Safeguarding training, however felt that an update should be arranged and would arrange an update for all staff and plans to contact the local authority to do so. The homes AQAA records that, I always personally listen to complaints and usually am able to act on them straight away. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Chaseborough Residential Home continues to maintain a clean and suitable environment for its stated purpose and the people who live at the home can be assured that they will live in comfortable home that is regularly maintained. Evidence: The home is safe and well maintained and suitable for its stated purpose. It is very comfortable, warm and light home. Several people living at the home confirmed this is usual. One relative commented that the home is, Always clean. A tour of the building confirmed that the home was clean and tidy, with no offensive odours. All bedrooms and communal areas were pleasantly decorated. Bedrooms have been fitted with door locks and therefore people are able to lock their doors should they wish for privacy or to secure their belongings when they are not in their room. However one bedroom door lock was inappropriate, it was only lockable from the outside, and a discussion was held with Mrs. Marshall who agreed to changing this lock. Since the last inspection the home has continued to update some areas where needed and the home has benefited from a newly fitted kitchen. One person spoken with said their bedroom door was too heavy to open and walk through with a walking frame. Care Homes for Older People Page 17 of 25 Evidence: Mrs Marshall stated that she has plans to fit electro magnetic door to some rooms for the comfort of people living in the home. The homes AQAA records under, what we could do better, We aim to have more decorating done and some new carpets which have not been possible in the current economic climate. Staff had access to disposable gloves and aprons to help prevent the risk of cross infection. And all areas of the home were found to be clean and odour free. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training is encouraged and this enables people who live at the home to receive the best possible service. People living at the home are supported by well-motivated and caring staff in sufficient numbers to meet the needs of those currently living at the home. Evidence: The homes rotas and the staff confirmed that there is sufficient staff employed to care for the number of people currently living at the home. On the day of the inspection there were 14 people living in the home and on duty were the Registered Provider, Mrs. Marshall and 3 care staff. A cleaner would normally be available but was currently on holiday. Thus providing evidence that the home had sufficient staff to support people currently living in the home. All of the staff on duty during the inspection were spoken with and some confirmed that they hold a NVQ qualification. The manager confirmed 10 of the 13 staff employed within the home currently hold this qualification. Examination of staff files showed that most staff had the required pre-employment checks, including CRB (Criminal Record Bureau Disclosure) in place ensuring as far as possible unsuitable staff are not employed. Care Homes for Older People Page 19 of 25 Evidence: One newly employed staff member did not have a second reference held on file. There was evidence that this reference was applied for and the owner agreed to obtain it. This staff member did have there last employers reference, a POVA check and a completed CRB in place. Many of the care staff employed at the home are long serving staff members having worked at the home for a number of years therefore have a great deal of experience working with older people. Several people living in the home and a relative were able to confirm that the care they received is very good. All the staff members were interviewed during this inspection and were able to confirm that regular training is offered. Recent training included Manual Handling, Food Hygiene and Medication training. One staff member confirmed they are currently doing Dementia Awareness training. The home has a formal Induction package available, however the owner, Mrs. Marshall, confirmed that she had not used this for the last employed staff member. The homes AQAA states, We generally keep our staff for long periods of time. One staff member said, Very happy working here. The people living at the home said of the staff Very good and another saying The staff are excellent and a family member said of their relatives care, They have helped her settle in well and she is happy here. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to be appropriately managed for the benefit of the residents. There were areas where further attention will improve the overall rating. Evidence: Mrs Marshall continues to own and manage the home and works within the home almost on a daily basis. Mrs Marshall has a NVQ level 4 in care and holds the Registered Manager Award. Mrs. Marshall has run the home for a number of years and had a wealth of experience. Mrs Marshall has a excellent relationship with the people living in the home, the staff team and family and professionals visiting the home. This helps to ensure that the home is run in the best interest of people living in the home. The yearly completed Quality Assurance surveys were held in the home and all showed positive comments. This included the following comments, I am so well looked after and another saying, Top marks to Chaseborough House for care in the home. Care Homes for Older People Page 21 of 25 Evidence: The home looked after spending money for some of the people living in the home. The records showed a clear audit trial of income, expenditure and balances held. However one balance was checked and found to be incorrect. Mrs. Marshall stated that it is only her who is responsible for managing the money held and would look at the records and balance sheets and ensue the accounts are rectified. Supervision is still carried out informally with the providers stating no records are held. However the staff interviewed felt they were supported by the providers and were able to approach and discuss any issues. The AQAA states under what we could do better, My Induction procedure is not as good as it should be. Sampling of records indicated equipment is serviced regularly and maintained in good order. Health and Safety is a priority in the home and records examined showed fire safety training and fire protection is in place and up to date. The accident records were accurate and files examined showed that information is recorded onto accident forms and also written into peoples daily records with appropriate action taken when needed. Good health and safety practices reduce any unreasonable risk, affecting people living at the home, to an acceptable level. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 16 All Controlled Drugs should be stored and administered correctly. All personal information on people living in the home should be recorded separately to cover the Data Protection Act. All staff should have 2 references held on their file. 3 29 Care Homes for Older People Page 24 of 25 Helpline: 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). 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