Care Home: Chaseside Residential Care Home

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well What has improved since the last inspection? Since the last inspection a number of improvements have been made. The home`s Statement of Purpose and Service User Guide that tells prospective residents, their relatives and any other interested persons about the home have been revised and updated. All newly appointed care staff now receive `Skills for Care` induction training. This makes sure that all staff have the basic skills to provide a good quality of care. The environment of the home has improved with some new carpets, a new boiler and a new roof. In addition, some patterned carpets have been replaced with a plain carpet and toilet doors have been painted red to make them more distinguishable. The outdoor area has received a substantial makeover and now provides a very attractive and welcoming area with flowerbeds, sensory ornaments, hanging baskets, tables, chairs and umbrellas. Residents were very pleased with this improvement. A protected mealtime has been introduced. This is to ensure that mealtimes are more relaxing and residents less distracted. Finger foods are provided for resident who prefer to wander at mealtimes rather than sit down at the table. CARE HOMES FOR OLDER PEOPLE Chaseside Residential Care Home St Georges Square St Annes Lancashire FY8 2NY Lead Inspector Denise Upton Unannounced Inspection 5th August 2008 08:50 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 Chaseside Residential Care Home DS0000038212.V365679.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. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chaseside Residential Care Home Address St Georges Square St Annes Lancashire FY8 2NY 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) 01253-724784 01253-838936 Mr Philip Tandy Mrs Denise Lynne Hayes Care Home 24 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (7), Physical disability (1) of places Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 24 service users to include:*Up to 24 service users in the category of DE (Dementia), *Up to 6 service users in the category of OP (Old age not falling within any other category) 14/09/06 Date of last inspection Brief Description of the Service: Since the last visit to the service, Chaseside Care Home has changed the category of registration and now accommodates people with a diagnosis of dementia. However there remain a small number of residents who have lived at the home for a considerable period of time that do not have dementia. These people made a positive choice to continue to live at the home when the category of registration was changed. In future, only people with dementia will be admitted to Chaseside Care Home. Mr Phillip Tandy owns the home, however as Mr Tandy is not in day-to-day control of the home, the home’s manager is also registered with the Commission For Social Care Inspection and this person has responsibility for the day-to-day management of the home. Chaseside Care Home is located in a quiet residential area of St Annes but in close proximity to the main shopping centre, a local park and community facilities and resources. The home is arranged over three floors with the majority of residents accommodated in single bedroom accommodation. Only one bedroom is for shared occupancy. Communal areas of the home consist of two lounges, a separate dining room and a smaller dining room. Although bedroom accommodation does not provide an en-suite facility, bathing and toilet facilities are sufficient in number, conveniently situated and provided with appropriate aids to promote independence. A passenger lift is provided. There is a lawn area with flowerbeds to the front of the building and a patio area to the side with flowerbeds, hanging baskets and tables and chairs for residents to enjoy in the summer months. In order to ensure that residents are kept safe, a number of keypads have been provided to certain internal doors located in various areas of the home and to one external gate. Residents who are mentally able are well aware of the keypad code and use the doors in question independently and with ease. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 5 These same residents are also provided with a key to the building to enable independent access to the home. The present rate for residential care charges at Chaseside Care Home ranges from £332.00-£440:00 per week. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 6 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 people who use this service experience good quality outcomes. This site visit took place over a mid weekday and in total spanned a period of approximately ten hours. For part of the day an expert by experience also visited the home and spoke with a number of residents to order to gain their thoughts and feelings about living at the home. The expert by experience also viewed the environment of the home and spoke with a number of residents, staff and some visitors who were visiting their relative living at the home. The expert by experience also enjoyed a meal with residents and participated in a range of activities organised by a carer in order to provide social stimulation. An expert by experience is a person who because of their experience of using or visiting a care home(s) visits a service with an inspector to help them get a picture of what it is like to live in the home. During the course of the day the inspector also spoke with the registered manager, the deputy manager and two care staff. In addition, brief general discussion also took place with several other residents who were ‘at home’. A number of records were examined and a tour of the building took place that included communal areas of the home, the laundry, kitchen and some bedroom accommodation. Four, Commission for Social Care Inspection resident surveys were completed and returned along with two staff surveys. This information also helped to form an opinion as to whether Chaseside Care Home was meeting the needs and expectation of the people who live there. The vast majority of responses provided on the survey forms were very positive about the level of care and support provided and the staff group. This site visit was unannounced however prior to the visit, the registered manager completed an Annual Quality Assurance Assessment (AQAA) that provided further important information. All of the core standards identified in the National Minimum Standards, Care Homes for Older People were assessed during the course of the visit, along with the single requirement and three recommendation made after the last inspection. What the service does well: Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 7 Chaseside Care Home has a group of staff that know the needs of people living at the home well. The home provides a relaxed atmosphere and the quality of care is good. Residents are comfortable living at the home and get on well with the staff team. The expert by experience commented that, “This home needs quite a lot of maintenance work to bring the building and décor up to a really good standard BUT most important the caring is there”. There are good systems in place to make sure that the registered manager has a good understanding of the needs and requirements of people before they live at the home. This is to make sure that people are only admitted to the home if their needs, wants and wishes can be met. The registered manager makes sure that staff are well trained so that people’s needs and requirements are well met by a competent staff team. Care plans, that tell staff what the individual resident can do independently, or what help may be required are in the main, detailed and comprehensive. This helps to ensure continuity of care. What has improved since the last inspection? What they could do better: Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 8 There are a number of ways that the home could further improve to make sure that residents receive a good quality service. The hot water supply in some bedroom accommodation is limited and arrangements must be made to ensure that an adequate hot water supply is available from all hot water outlets in resident accommodation. The hand written records on drug administration records should be signed, dated and countersigned to ensure accuracy. Information should also be made available to make sure that staff know under what circumstances prescribed medication, that is not required on a regular basis, should be given. Although some risk assessments are in place, and resident needs are fulfilled, whenever a risk is identified a formal risk assessment should be undertaken with any important outcomes written in the care plan. 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. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 9 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 Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 10 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): 1 in part & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose and Service User Guide are comprehensive and detailed and have been recently revised to ensure there is accurate information for the reader. The needs of those wishing to live at the home had been thoroughly assessed prior to admission so that the home was confident that the staff team could meet individual needs. EVIDENCE: Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 11 As recommended at the last inspection, the home’s Statement of Purpose and Service Users Guide have been revised to ensure that they contain accurate and up to date information. These booklets tell prospective residents, their family and any other interested enquirer about the facilities at the home and services provided. Each newly admitted resident is provided with an individual copy of the Service User Guide. From discussion with the registered manager it is understood that in the very near future, the Service Users Guide is to be made available on tape as well as in a written form. This is to make sure that as many residents as possible, including those with a visual disability, can access and understand the information provided. Residents are only admitted to the home if their individual needs and requirements could be met. It is normal practice at Chaseside Care Home that prospective resident’s are visited by the registered manager in order to undertake an initial assessment of strengths and needs and to provide further information in respect of the home. In addition, the prospective resident and/or their family are invited to the home to assess the accommodation for themselves, meet staff and existing residents in order to make an informed choice. The information gathered is also sometimes further supplemented by information made available from professional assessments undertaken by Care Managers or through hospital discharge information. This combined information is then collated and provides a basis for the initial care plan. During the course of the inspection three residents were ‘case tracked’ This included looking at all the written information about these people to make sure that the records were detailed, accurate and guided staff to ensure a good quality of care. Recently a new ‘care assessment fact book’ has been introduced to gather information about a prospective resident’s needs, requirements, wants and wishes prior to admission. This was very detailed and comprehensive and gave a clear indication as to whether the requirements of the prospective new resident could be met at the home. Whilst it was clear that the needs of recently admitted people to the home were being met, there is a requirement that any person who has been assessed for possible admission to a care home must receive written information following the pre admission assessment. This should confirm the outcome of the pre admission assessment and that the prospective resident’s current needs and requirements could be met at the home. This should be provided prior to admission. There was no evidence that this had occurred. Chaseside Residential Care Home DS0000038212.V365679.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): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear and consistent care planning system in place that gives specific guidance to staff in order for them to satisfactorily meet needs and requirements. Some risk assessments are in place however occasionally a risk is identified but no formal risk assessment has been undertaken The health care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication in this home is well managed promoting good health. Personal support is provided in such a way as to promote and protect resident’s privacy, dignity and independence. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 13 EVIDENCE: All three of the residents files examined contained a person centred care plan. The plans contained good detailed information in order to guide staff and to ensure the support needs of the individual resident was met. The care plan had been generated from the pre-admission information obtained before the resident had been admitted to the home and from the ongoing continuing assessment following admission. The plans of care seen were well written documents, easy to understand and considered all areas of the individuals life including health personal and social care needs. A number of risk assessments are routinely undertaken covering a range of individual needs when a new resident is admitted to the home. This is to make sure that the most common areas of risk are assessed and where necessary minimised. However in respect of one person ‘case tracked’ the on-going assessment indicated periods of wandering/restlessness, unpredictable/variable mood and aggression but specific risk assessments in respect of these matters could not be evidenced. It is recommended that in order to reduce or eliminate the risk, whenever a risk is identified, a formal written risk assessment be undertaken with significant outcomes incorporated in the care plan. It is essential that care staff be provided with sufficient written information about how to minimise the risk and to enable a consistent response to be provided. In the main there was evidence of routine monthly reviews of care plans with detailed written information of any amendments to the care plan. However there were some inconsistencies. For example in respect of one resident, there was clear evidence of a regular review of the care plan from April 2007 to December 2007 and March 2008 to June 2008 when the care plan had been amended and updated. There was nothing to evidence that the care plan had been formally reviewed at the beginning of 2008 or after June 2008. Whilst there is nothing to suggest that the needs and requirements of this person were not been met during these periods, it is strongly recommended that all care plans be formally reviewed on a least a monthly basis or more frequently if required. The outcome of the formal monthly review should be recorded. As observed, where ever possible, care plans had been signed by the resident or their relative as acknowledgement and understanding of the content. Three of the four residents who completed the Commission for Social Care Inspection (CSCI) surveys stated that they always received the care and support they needed. One person said that they “Always found the care excellent”. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 14 All the residents that completed a CSCI survey said that they always received the medical support that they needed when they needed it. Residents’ health care needs were being well met by the additional input of a variety of other professionals involved in the overall care of people living at the home including mental health professionals. There is a good relationship with health and social care staff in order to maintain health and social well-being. The administration and recording of medication is generally well managed at Chaseside Care Home. The medication administration records of the residents that were ‘case tracked’ were examined and found to be generally well recorded and accurate. However it is recommended that PRN medication protocols be in place for each individual resident’s PRN medication. This will provide clear written guidance to staff when it is appropriate to administer PRN medication. It was also noted that on one occasion a hand written entry on the drug administration record had not been signed or dated. It was also evident that the hand written drug administration record had not being countersigned by a second person to confirm that the hand written entry was an exact replica of the dispensing label supplied from the pharmacy. It could have serious consequences if medication details on the hand written drug administration record were not the exact replica of the pharmacy label with the possibility of medication being administered not as prescribed. All staff have received appropriate medication training and staff with responsibility for medication administration have also received additional training to ensure they are proficient in this task. Any resident who has capacity and wish to do so are enabled to self medicate within a risk assessment framework. A locked facility is provided in individual bedroom accommodation for the safe storage of items of a personal nature. An amended Regulation has recently been introduced with regard to the storage of controlled drugs in care homes. The requirements of the amended Regulation were explained to the registered manager. These requirements must be put into place within a specified time scale. It is understood that the registered manager is to establish if the existing medication storage facility meets the new regulation and take appropriate action if necessary to comply. Staff were observed to speak appropriately to residents and treat them with respect. Residents who were able confirmed that they felt that their privacy and dignity was well respected by staff. The expert by experience commented that, “The residents appear to be treated with dignity at all times, and encouraged to retain some independence where possible”. The expert by experience also noted that, “One resident’s skirt has risen up well above her knees, and the first carer to come into the room discreetly pulled it down”. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 15 Staff had a good overall understanding of the specific needs of each person living at the home and were seen to be patient, kind and respectful when interacting with residents. The home has an equal opportunities policy in place and promotes the faith of each resident usually by enquiring about home visits by a representative of their chosen faith. Importance is given to ensuring that no individual is treated differently from others with regard to their gender, faith or culture. This is achieved by supervision, hand over meetings and through observation of the interaction between residents and staff. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to maintain contact with the local community and their family and friends to ensure these relationships are sustained. Residents experience the lifestyle that satisfies their social, cultural, religious and recreational interests and needs. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets service users taste and choice. EVIDENCE: Residents and their relatives are informed at the time of admission that visitors are made welcome at any time of the resident’s choice. This information is also Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 17 provided in the Service Users Guide. As observed, it was clearly evident that residents can entertain visitors of their choice at a time to suit them either in a communal area of the home or their individual bedroom accommodation. It was apparent that there is a good relationship between relatives and the staff group that helps to create a feeling of trust and open communication. Activities and hobbies that a prospective resident enjoys are established during the pre admission assessment. Activities are then arranged to take into account the interests of the individual and their current level of ability. Some residents enjoy a range of activities while other residents prefer to gain enjoyment by watching an activity rather than actually participating. The dialogue among residents and staff surrounding the activity can also be enjoyable. Since the last inspection a wider range of activities has been introduced and staff also spend one to one ‘pampering sessions’ with residents. During the course of the visit, the expert by experience spent time with residents during afternoon activities and joined in a game of skittles and patting balloons that everybody in the room joined in with. The expert by experience commented that, “It was very good to see so many residents taking part in activities. Extra chairs had to be brought in”. Outings are sometimes arranged and an outside entertainer visits the home once a month and a local choir also visits. The social care needs of the more able residents are also taken into account. One resident is still a member of a choir and another resident attends a regular meeting at the local Blind Society. Residents who are able also access other community services and resources independently. The Annual Quality Assurance Assessment completed by the registered manager confirmed that staff are regularly reminded that the activities provided are an equally important part of the care provided to residents. Whilst it was evident that a range of activities does take place, this is not always recorded. In order to ensure that all the good social activity work provided can be evidenced, it is recommended that both arranged and ‘ad-hoc’ activities be recorded. To further improve the provision of one to one time with residents, the registered manager is planning to introduce a system where by each key worker will spend at minimum, one hour a week on an individual basis with the residents they are responsible for. All residents with mental capacity are encouraged and enabled to retain independence in respect of financial affairs for as long as they wish to and as long as they are able to. However in reality the majority of people living at Chaseside Care Home require assistance in this task. Information regarding Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 18 local advocacy services is available for resident or their family to access independently. Through discussion with a resident and observation of some bedroom accommodation it was confirmed that residents are encouraged to take personal possessions such as photographs, ornaments or soft toys with them into the home to make their individual bedroom accommodation more homely and comfortable. Chaseside Care Home has varied three-week menu available that is frequently reviewed. There is a wide choice of menu that incorporates any specialist diets that may be required. The home liaises closely with the General Practitioner and dietician to ensure that any dietary needs or difficulties are addressed and resolved as quickly as possible. The home has also recently introduced a ‘protected mealtime’ arrangement and picture menus. This helps to ensure a calm and relaxed mealtime environment and enable residents who have some difficulty in understanding verbal or written communication, to make a positive choice about what they would like to eat. Menus include finger foods for residents who prefer to wander rather than sit at meal times. The chef has successfully completed his National Vocational Qualification (NVQ) thus providing improved quality of food and local suppliers of fruit, vegetables and meat are used to ensure quality and freshness. The home has also achieved Fylde Borough Council’s Certificate of Compliance in Care Catering. The expert by experience enjoyed a mid day meal with a number of residents and noted that there was a well balanced diet suitable for elderly people and that every effort was made to provide dishes that individuals favour. The tables were laid with clean white cloths and paper serviettes were provided. Residents were encouraged to remain independent with the assistance of special cutlery and crockery as required however staff were on hand to offer discrete assistance if required. Residents spoken with all said that they had enjoyed the food served. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 19 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system and adult abuse policy and procedures for the protection of residents. Members of staff have been provided with adult abuse training that helps to protect residents. EVIDENCE: Chaseside Care Home has a comprehensive, complaints policy in place, which included all of the required detail and outlined the steps that could be taken if a resident was unhappy with the service provided. The policy is made available to residents and their relatives by way of the Statement of Purpose and Service User Guide. The home’s complaint procedure is also displayed in each individual bedroom and in the main entrance to the home. Since the last inspection, The Commission for Social Care Inspection received one complaint about the home. This was followed by a further concern of a Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 20 similar nature. The homeowner was asked to investigate the issues using the home’s internal complaint procedure. The complaint/concern was found to be in the main, unsubstantiated. The issue that was substantiated, was addressed by the homeowner as a matter of urgency As observed, the relationship between staff, residents and relatives was relaxed and friendly that helps to address any areas of concern immediately. Residents that completed a Commission for Social Care Inspection (CSCI) survey all said that they would know who to speak with if they were unhappy about anything. All staff received written information with regard to complaints, grievance procedures, whistle blowing and adult protection issues which they are required to read, understand and sign to this effect. To further reinforce staff knowledge of dealing with complaints, complaint scenarios are discussed at team meetings with staff encouraged to think how they would respond to a complaint being made. Chaseside Care Home continues to have in place a variety of policies and procedures for the protection of residents. This includes an Adult Protection Policy based on the `No Secrets In Lancashire’ document and a whistle blowing policy to help protect people living at the home from abuse or discrimination. Staff training in respect of adult protection is mandatory and all but the most recently appointed members of staff have received this training. It is understood that this training will be provided to all new staff along with refresher training in respect of existing staff in the near future. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 21 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): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is generally good and provides residents with a safe, comfortable and homely place to live. EVIDENCE: As identified at previous inspections, residents at Chaseside Care Home live in comfortable accommodation that is welcoming, homely and designed to suit the needs of the people who live there. The home is situated close to the Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 22 centre of the town and within easy access to local shops and community facilities. There is a lawned area to the front of the home and a recently landscaped patio area with tables and seating to the side of the building that resident’s can enjoy in the summer months. This area is planted with fragrant flowers and sensory objects and the flagged paths give residents easy access to walk round and enjoy the outdoor space. A new wooden bench has also been provided that was recently purchased by the family of a former resident. The layout of the home gives residents opportunity to move freely round the building and access all areas with ease. The home is generally maintained to a good standard, and decorated and furnished to meet the needs of the residents. Some of the patterned carpets have been taken up and replaced with plain carpets, this was the result of staff observing residents, some of whom thought that the pattern in the carpet was an item on the floor. The toilet doors have been painted red so that they are more easily distinguishable for residents. A new roof has been fitted along with a new central heating system and the fireplace has been removed from the main lounge, making this a safer place for residents to be. Keypads have been provided to a number of internal doors in certain areas of the home, the back door, the stair gate and to an external gate. Previous discussion with a number of residents confirmed that this was not a problem for the more independent resident. All keypads are provided with the same code number for ease of use and several residents were well able to recall the number from memory and demonstrate how the keypads operated. In addition, all residents have been given a written reminder of the code number that can be carried at all times. Residents where appropriate have also been provided with a key to the back door to the property for independent access. One resident was seen to use this facility with ease. The layout of the home gives residents opportunity to move freely round the building and access all areas with ease and there is a passenger lift to access all areas of the building. Communal areas are light and airy with pleasant views. Some bedrooms have been refurbished and the remaining bedrooms are furnished to an adequate standard. However it is understood that there plans to redecorate and refurbish the remaining bedrooms in the near future. Residents were able to personalise their rooms with their own belongings helping them to feel comfortable and settled in the home. It was noted that some of the wooden window frames are in need of attention and that the first floor bathroom although serviceable and clean was in need of attention. It is understood that a new bath hoist has recently been fitted and this bathroom is also to be refurbished. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 23 The expert by experience did suggest that some pictures of old St Annes, Blackpool trams or donkeys may help to stimulate conversation for the more dependent resident. It was also noted that there was a shortage of toilet roll holders. Toilet rolls were not easily accessible with some being on shelves that were too high to reach or alternatively on the cistern at the back of the toilet. The manager did explain however that one resident pulled the toilet roll holder off the wall and that some residents will block the toilets with toilet rolls as they did not necessarily recognise the implications of their actions. The expert by experience, whilst acknowledging that few resident actually use the stairs, also commented that a second hand rail on the opposite side to the banister would be helpful for residents that use the stairs. During the course of the visit it became apparent that a number of bedrooms did not have hot running water. It is understood that one bedroom has no running hot water at all and in several other bedrooms the water pressure is poor and the water has to run for a considerable period of time before any hot water is available. The registered manager explained that this was because the new boiler was not working properly as there had been a leak in the boiler. In these instances, staff are having to carry hot water from the bathroom to resident’s bedroom. This is unsafe for both staff and residents. There is a requirement that hand washbasins are fitted with a hot and cold water supply and attention should be given to this matter as a matter of urgency. As at previous inspections, the home remains clean, pleasant and hygienic with a variety of policies and procedures to advise staff in the control of infection. Laundry facilities are sited in the basement area of the home and do not intrude on residents. The industrial washing machine has the capacity to meet disinfection standards and floor finishes are easily cleanable. An environmental risk assessment is in place in respect of staff having to climb steps to access the washing machine and dryer that is clearly displayed in the laundry room. Chaseside Residential Care Home DS0000038212.V365679.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): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The number and skill mix of staff on duty were sufficient to ensure that the assessed needs of residents were met. Staff had received a variety of training to ensure that they were competent to do their job. The recruitment practices are good to protect those living at the home. EVIDENCE: The staffing levels at Chaseside Care Home are determined by the individually assessed needs of residents accommodated. Additional staff are on duty at peak times of activity and staffing levels are increased when a resident is ill for a period of time or on admission. All night staff have ‘waking watch’ responsibility with one person permanently based on the top floor where the more vulnerable residents sleep. There will be sufficient ancillary staff Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 25 employed, once the newly appointed domestic cleaner commences employment, to ensure standards in respect of domestic and catering are maintained. Currently 50 of the care staff team have achieved a National Vocational Training qualification. (NVQ) This is an area that the manager would like to improve to ensure that all staff undertake this training and ensure a competent and qualified staff team. The remaining care staff have now registered to undertake this award and are waiting for a commencement date. One difficulty has been the retention of staff since the introduction of dementia care. In order to address this issue, the management team are planning to introduce new job descriptions/job specifications and have an improved probationary period. Both members of the care staff team spoken with confirmed that sufficient staff were on duty to address the current needs of residents accommodated. One of the carers commented that she felt, “a good standard of care is provided, I would put my mum in here”. Residents who completed the CSCI surveys confirmed that staff were always available when they needed them and that they received the care and support they required. Chaseside Care Home continues to operate a structured recruitment process in order to protect residents. From observation of three recently appointed staff member’s personnel file, it was evident that the policy and procedures in respect of staff recruitment had been followed, including an application form, health questionnaire, formal interview, references and a Criminal Records Bureau, POVA First clearances had been obtained prior to the applicants actually taking up post at the home. The registered manager at Chaseside Care Home has a particular interest and skills and qualifications in staff training. There is a clear commitment to the training and development of all staff. ‘Skills for Care’ induction training standards are provided to all newly appointed care staff and NVQ training at various levels is strongly encouraged. Staff also undertake a variety of further training appropriate to their needs to ensure a skilled staff team that offers consistency and a good quality of service to residents accommodated. Most of the staff team have undertaken equality and diversity training and further mandatory training courses are booked to take place in the near future. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the people living there. The health, safety and welfare of both residents and staff was promoted and protected. EVIDENCE: Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 27 The registered manager is very experienced and well qualified to manage a care home for older people and has recently completed an NVQ Level 4 in management and staff development and the Registered Managers Award. The registered manager also achieved a Certificate in Social Service, Diploma in Management and a D32/D33/D34 training certificate. Since the last inspection the position of two deputy managers has been created in order to strengthen the management team. There is a range of internal and external quality assurance systems in place to ascertain if the home is well managed and fulfils residents’ expectations. Chaseside Care Home has achieved the Investors in People Award and there are clear lines of accountability within the home and the homeowner. Internal systems include staff meetings and residents meetings for residents with ability and who choose to attend. In addition quality assurance questionnaires are provided on a periodic basis so that residents, relatives and staff can have their say about the running of the home and comment with regard to resident needs being addressed satisfactorily. One of the most important ways of finding out what a resident thinks is through daily discussion with staff. This is especially important with regard to people who may have difficulty understanding what goes on at a residents meeting but is able to converse far more easily with a carer on a one to one basis. Residents’ financial interests are safeguarded by the financial procedures adopted by the home. All residents, wherever possible, are encouraged to remain financially independent or assisted in this task by a family member. As again observed during the course of the inspection, when the home does retain monies or valuables in respect of a resident, this is accurately recorded and secure facilities are provided for the safekeeping of monies and valuables held on behalf of the individual resident. Formal staff supervision is an area that the registered manager knows needs to be improved. It is understood that it is planned that this task will be delegated to the deputy managers. However staff are informally observed on a daily basis that helps to ensure residents needs are being met appropriately. Some formal supervision has taken place but this has been, in the main, infrequent. The registered manager said that sometimes staff discuss an issue that should be discussed during formal supervision but this is not recorded. All care staff should receive formal one to one staff, documented, supervision at least six times a year. This should cover at minimum all aspects of practice, philosophy of care and career development needs. It is essential that all staff that supervises others have the knowledge, skills and abilities to undertake the task. The staff training matrix was not up to date at the time of inspection however all staff are required to undertake mandatory heath and safety training, that includes, moving and handling training, fire safety training, basic first aid Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 28 training and food hygiene training. However because of the number of recently appointed staff, some members of the care staff team have yet to receive this important training. It is understood that this training will be provided as soon as possible. It is also recommended that all staff be provided with infection control training. Chaseside Care Home continues to have available a variety of policies and procedures in place to ensure the health, safety and welfare of residents, visitors and members of staff. At the time of inspection, various records, maintenance records and certificates relating to equipment and instillations were examined and found to be up to date and in good order. A number of environmental risk assessments are also in place that helps to protect residents, visitors and staff from harm. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 29 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 3 X 3 X X N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 30 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. 1 Standard OP3 Regulation 14(1)(d) Requirement All prospective residents must be informed in writing of the outcome of the pre admission assessment. The storage of controlled drugs must be maintained in line with the recently amended regulation All hand washbasins in resident accommodation must be provided with a hot and cold water supply. Timescale for action 30/09/08 2 3 OP9 OP19 13(2) 23(2)(j) 05/11/08 30/09/08 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. 2 3 Refer to Standard OP7 OP7 OP9 Good Practice Recommendations Whenever a risk is identified a formal risk assessment should be undertaken with significant outcomes incorporated in the care plan. All care plans should be formally reviewed on at least a monthly basis and amended as required. PRN protocols should be in place to advise staff when the medication should be given. DS0000038212.V365679.R01.S.doc Version 5.2 Page 31 Chaseside Residential Care Home 4 5 6 7 8 9 OP9 OP12 OP19 OP19 OP36 OP38 All hand written entries on the drug administration record should be signed and dated and countersigned by a second member of staff to confirm accuracy. It is recommended that all resident social activities be recorded. Some of the windows should be given attention to prevent further deterioration. Consideration should be given to replacing the toilet roll holders and providing a second hand rail to the stairs. Formal documented staff supervision should take place at least six times a year. All mandatory health and safety mandatory training should be provided to staff that have not undertaken this training. Infection control training should also be provided. Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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. Extracts may not be used or reproduced without the express permission of CSCI Chaseside Residential Care Home DS0000038212.V365679.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!