Care Home: Chesswood Lodge

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What the care home does well The needs of prospective residents are assessed before they move into Chesswood Lodge. This means that prospective residents will know that the care home will be able to meet their needs. The accommodation provided for residents is clean and well maintained. It has also been furnished in a comfortable and homely manner. Residents are provided with a range of activities and entertianments to enjoy. They are also able to be involved with the daily chores of the home if they wish and according to their abilities. All staff have been provided with training to ensure they have the necessary skills to support residents and meet their individual needs. Residents, their families and staff are regularly consulted with regard to the day to day running of the home. This ensures the home is run in the best interests of residents. What has improved since the last inspection? A new call bell system has been fitted in all areas occupied and used by residents. All hot water outlets have been tested by a qualified plumber. Where they have failed, outlets have been repaired. Hot water temperatures have also regularly tested by a suitably qualified person to ensure residents are not at risk of scalding themselves. What the care home could do better: The manager must ensure all staff receive individual supervision on a regular basis. This will mean staff will receive the support and guidance they need. Regulation 26 reports must be completed and made availible to view in the home. The manager has been advised to review residents` care plans to ensure they include sufficent information or guidance for staff with regard to the level of care each resident requires. This will mean all care staff will know what action they shoudl take to ensure residents` needs have been met. The manager has also been advised to monitor the testing of hot water temperatures to ensure they are carried out as required. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chesswood Lodge 49 Chesswood Road Worthing West Sussex BN11 2AA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Bannier     Date: 1 5 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 33 Information about the care home Name of care home: Address: Chesswood Lodge 49 Chesswood Road Worthing West Sussex BN11 2AA 01903230886 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Chesswood Lodge Ltd care home 14 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 14 14 The maximum number of service users to be accommodated is 14. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Chesswood Lodge is registered with the Commission for Social Care Inspection to provide care for up to fourteen persons in the registration categories Mental disorder and Dementia over 65 years of age and includes one named person in the category of Mental Disorder over the age of 50 years. The property is situated in Worthing in a residential area close to a well-established park, local transport, railway and shops. The sea front, main shopping centre with all its amenities is approximately ? mile away. The home is a large mature house with plenty of parking to the front and a secluded grassed garden to the rear. The accommodation comprises of 10 single bedrooms - 4 Care Homes for Older People Page 4 of 33 Brief description of the care home with en-suite facilities and 2 double bedrooms. There is a lift to the first floor but the home is not suitable to accommodate anyone in a wheelchair due to dimensions of the corridors. Chesswood Lodge Limited privately owns the service. Mrs Shoai, a director of the company is the registered responsible individual. The regiostered manager is Mrs Jacqueline Constable and is responsible for the day to day running of the care home. The current fees for the home range from GBP419.00 to GBP439.00 per week Care Homes for Older People Page 5 of 33 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 has followed the Inspecting for Better Lives methodology and is called a key inspection as it assesses those standards determined by the Commission as key standards. This inspection will also determine the frequency of inspections hereafter. The registered provider returned an Annual Quality Assurance Assessment prior to the inspection. Some residents and staff were sent surveys by the Commission entitled Have Your Say. These are designed to enable residents and staff to give their opinions about how the care home is being run. The information received from these documents will be referred to in the report. A visit to the care home was made on Thursday 2nd April 2009. As this was an Care Homes for Older People Page 6 of 33 unannounced inspection we gave the manager and provider no notification of our intention to visit. We spoke to some residents and observed care practices. This helped us to form an opinion of what it is like to live in this care home. We also viewed some of the accommodation and examined some records. The visit lasted approximately five hours. The manager was present during the inspection whilst the responsible individual arrived after we had started. 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 set out 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 8 of 33 Care Homes for Older People Page 9 of 33 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 10 of 33 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. Residents care needs have been assessed before they move into Chesswood Lodge. Evidence: We identified the names of three residents to case track. We looked through the care records of each resident. We found evidence that residents care needs had been assessed before they moved into the care home. We spoke to care staff who were on duty during our visit and observed care practices. We concluded that staff understood the needs of residents and what they were expected to do to ensure they have been met. We also spoke to several residents who were able to confirm they have been well cared for. One resident told us, The staff treat us like human beings! Care Homes for Older People Page 11 of 33 Evidence: Information provided in the AQAA confirmed that, All prospective service users are fully assessed by a qualified nurse before a decision is made to place them in the home. We could find no evidence that demonstrated this care home provides intermediate care. This standard is, therefore, not applicable on this occasion. Care Homes for Older People Page 12 of 33 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. Care plans have been drawn up fro each resident using information from care assessments. They set out each residents health, personal and social care needs. Individual health care needs have been met. Residents are considered to be incapable of administering their own medication. This is handled by care staff. The homes polices and practices for dealing with medicines protects residents. Residents are treated with respect and their right to privacy has been upheld. Evidence: During this visit we found evidence that there was information in residents care plans about the physical health and personal needs of residents. This is based on information gathered by pre admission assessments. We also saw evidence that they are reviewed regulary to ensure the information is up to date. Care records we saw included visits Care Homes for Older People Page 13 of 33 Evidence: made by GPs and district nurses. However, care plans do not routinely provide information to staff about the level care each resident requires and the action that should be taken to meet them. This was with particular regard to supporting residents with dementia. For example an assessment identified that a resident sometimes had difficulties understanding where they were and on occasion, could not recall recent events. The manager had not drawn up guidelines for staff to follow so the resident could be appropriately supported. Another care plan identified that staff should provide a resident with a supportive environment in order that the residents condition may be managed. There was no guidance to staff with regard to what action staff should take to provide such an environment. We spoke to the manager who agreed to include such information when care plans are next reviewed. We found evidence that residents were being well cared for physically. Residents we spoke to were clean and tidy and appropriately dressed. All surveys returned by residents confirmed they always receive the care and support they need. They also confirmed they always receive the medical support they need. One resident told us, I receive support when I want it. I like to be as independent as possible. All surveys returned by staff confirmed they have been given up to date information about the needs of the people they care for. One member of staff told us, The care plans are informative. We communicate up to date information between members of staff. Information provide in the AQAA confirmed that, The service users health, personal and social care needs are clearly written out in their individual care plans. All care plans are reviewed at least once a month with the service user or their family, but the family are always encouraged to discuss changes they would like immediately and not to wait for review. Nutritional risk assessments are carried out and monthly weight checks are recorded. The AQAA also confirmed, The home liaises with other healthcare professionals with referecne to tissue viablity and promotion of continence. Opticians and chiropodists visit on a regular basis or service users are taken out to appointments by staff. We looked at medication records. We noted that they had been well maintained and, with one exception, were up to date. The manager agreed to look into an incident where the medication record had not been completed. We also noted that staff who handle medication had been provided with appropriate training. We discussed the homes practices of storing and administering medication with the manager. She was able to clearly demonstrate that the homes practices protects all residents within the home. We were advised that, currently no residents are considered capable of administering their own medication. Care Homes for Older People Page 14 of 33 Evidence: Information provided in the AQAA confirmed, All staff receive training in dealing with medication and the homes policy on the receipt, recording, storage, handling administration and disposal of medication is strictly adhered to. We observed care practices and found that staff are respectful when speaking to residents and ensure residents are treated with dignity when personal care is being provided. Staff were seen to address residents using the name and title they prefer. One resident told us, The staff treat us like human beings. All surveys returned by residents confirmed staff listen to them and act on what they say. One resident told us, I feel the staff do their best to help me when I need it. The AQAA confirmed, Service users privacy and dignity is respected at all times, but most particularly when bathing, dressing, or using the bathroom. Staff receive training on how to uphold these rights during their induction period. Care Homes for Older People Page 15 of 33 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. Routines in the home are flexible, allowing residents to have control over their lives where possible and encourages residents to make choices about what they wish to do. Activities are offered to residents which take into account their hobbies and interests. The home supports residents in maintaining contact with family and friends. Residents receive a wholesome, appealing and balanced diet. Evidence: We spoke to several residents during our visit. We noted that some residents were enjoying breakfast in their rooms. One resident told us they are able to choose when they get up and at a pace which suits them. Later in the day we saw residents sitting in the lounge area having tea and biscuits. They were also listening to music and singing along to songs that they knew. We saw a number of photographs displayed on notice boards in the hallway. They showed residents and staff enjoying themselves at parties arranged at Chesswood Lodge to Care Homes for Older People Page 16 of 33 Evidence: celebrate various occasions such as Bonfire Night, Christmas and residents birthdays. Photographs also showed residents enjoying an exercise session which was entitled Music for Health. There were also photographs of events which took place outside of the care home. They included lunch and a pantomime at a local venue, a Christmas shopping trip and a walk in a local park. We spoke to two residents who were in a smaller lounge. This had been set up with a television, a video and DVD player and satellite television. The room had been decorated with pictures of film stars and personalities of the past. We were informed that this room is used by residents who enjoy watching films. We noted that a selection of films were available in video and DVD formats for residents to enjoy. Residents told us that they usually like to have a session of movie watching at the weekend. 75 of surveys returned by residents comfirmed there are always activities arranged by the home that they can take part in. One resident told us I take part in Music for Health, social trips e.g. the theatre, ocupational health activities. Two residents told us that, whilst activities are available, they do not always want to join in. 25 of surveys confirmed activities are usually available. One resident told us, There is a lot on offer, but sometimes I would like to do more quizzes and perhaps cooking activities. Information in the AQAA confirmed what the home does well. The provider has informed us that, We get information from the service user or a significant other with reference to past history, including interests and hobbies. Birthdays are celebrated with a special cake and recreational activities are held regularly. Residents told us they are able to have frequent visits from family members and friends. We did not meet anyone during our visit. However, we noted entries in the visitors book demonstrated that residents do receive visitors to Chesswood Lodge. Information in the AQAA confirmed that, Relatives, friends and other visitors are encouraged to visit when they want to. There are no set visiting hours. They are made welcome and offered tea and coffee. They are given a choice as to where they would like to be during their visit. Bedroom, quiet corner or communal areas. We observed some residents were involved in daily chores around the home. This included light cleaning, washing up and laying tables. Residents we spoke to confirmed they enjoy being involved in the day to day life of the home in this way. Information provided in the AQAA confirmed that, Service users go out shopping on Care Homes for Older People Page 17 of 33 Evidence: an individual basis, accompanied or unaccompanied as appropariate. Service users are encouraged to choose what they wear, where they sit and to make choices as far as possible. The main meal of the day is prepared from the kitchen of a larger care home owned by the registered provider. Residents are asked to choose from the menu the day before so that the right number of portions can be prepared and delivered. The food is transported to Chesswood Lodge in specially designed containers. We observed that, before serving, the food is put into ovens. We also observed the manager checked the temperature of food with a probe before it was served to residents. The provider has confirmed at our last visit that arrangement has been approved by the Environmental Health Officer. We were informed the main meal of the day consisted of pork chops with apple sauce, gravy, sauteed potatoes, carrots and green beans followed by bread and butter pudding and custard. We looked at the menu which stated that an alternative meal of chicken cooked in a tomato and onion sauce was available. As we saw no evidence of this we concluded that none of the residents had chosen this meal. We observed the meal being served to residents. It was attractively presented and looked very appetising. We spoke to residents after they had finshed their meal. They told us they enjoyed the food, which was tasty and to their liking. We were given copies of menus to look through. They demonstrated that a varied, wholesome and appealing diet has been provided to residents. An alternative main meal is available to residents each day. We were informed that the breakfast and evening meals are prepared at Chesswood Lodge. We noted that a range of appropriate food and ingredients were available in the kitchen to prepare such meals. Care staff in the home are expected to prepare and serve these meals. We looked through records of training staff have received. They included certificates which demostrated staff have attended training sessions regarding Food Hygiene We spoke to several residents during our visit. They informed us they were satisfied with the food provided. 75 of surveys returned by residents confirmed they always like the meals at the care home. One resident told us, I enjoy the varieties. 25 of surveys returned by residents confirmed they usually like the food provided. Information provided in the AQAA confirmed, There are set meal times but these are flexible. We use mainly fresh ingredients in all our meals and the menus are carefully chosen to provide the best nutritional value for our service users. Meals are always Care Homes for Older People Page 18 of 33 Evidence: presented in an appealing manner, including liquidised meals. An alternative menu is offered if they do not like the meal of the day. Care Homes for Older People Page 19 of 33 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. Residents know who to speak to and how to make a complaint if the are unhappy the care and services provided at Chesswood Lodge. The registered provider has put in place procedures to ensure residents are protected from abuse. Evidence: We noted that a written complaint procedure was on display in the front hallway of the care home. We examined the record of complaints received that the manager has maintained. This confirmed that the care home has set up an appropriate system for ensuring any complaints received are properly investigated. We noted that no complaints had been recorded since our last visit. All surveys returned by residents confirmed they knew how to make a complaint. Residents surveys also confirmed that they always know who to speak to if individual residents were not happy. Information in the AQAA confirmed, We have a complaints procedure that is displayed on the notice board and also in the service users guide. All complaints are recorded and acted upon. Outcomes are also recorded. Information provided in this document also confirmed that no complaints had been received in the past 12 months. We also examined records of staff training. This confirmed that staff have received Care Homes for Older People Page 20 of 33 Evidence: training in recognising and reporting abusive and neglectful practices. Residents we spoke to confirmed they were satisfied with the quality of care provided. They also confirmed they felt they were in safe hands. Information supplied in the AQAA confirmed that, All staff receive training on POVA and this regularly updated. The home has policies on adult abuse and whistle blowing. During our last visit we noted an incident which occurred in the the care home in February 2008. This resulted in a safeguarding allegation, a referral and an investigation. We also noted that, whilst the incident had been reported to us as required by regulations it had not been referred to West Sussex Social Services through local safeguarding vulnerable adults procedures. Mrs Shoai provided us with an action plan in March 2008, which confirmed that she would ensure contact details of the local social services helpdesk would be displayed in the managers office. Mrs Shoai also confirmed all staff would be made aware of relevant procedures and this information. We have also noted that information within the AQAA has confirmed that the homes safeguarding vulnerable adult procedures were last reviewed in June 2008. Care Homes for Older People Page 21 of 33 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. The environment is safe and has been well maintained. The care home has been kept clean and hygenic and is pleasant for residents who live there. Evidence: We looked at the private accommodation of several residents along with the communal areas, including the dining room and lounge areas. These areas were clean, decorated and furnished in a comfortable manner that met the needs of the residents accommodated. We also noted residents have been encouraged to bring personal effects and small items of furniture in order to make bedrooms as individual as possible. All surveys returned by residents confirmed the home is always fresh and clean. One resident told us, I sometimes help with hoovering and washing up etc. Residents we spoke to also confirmed they were very satisfied with the accommodation provided. During our last visit we noted that the call bell system was not working. This meant that residents had no way of calling for assistance, particularly if they were unable to get out of a chair or out of bed without assistance. On this occasion we noted that a Care Homes for Older People Page 22 of 33 Evidence: new call bell system had been fitted to all areas used by residents. We tested the system in one room and found that it worked. We also noted that, during our last visit that an incident had occured which resulted in a resident being scalded due to exceedingly high water temperatures. The resulting investigation by the Environmental Health Department found that there were insufficent safeguards in place to reduce the risk of this occuring. We also found it necessary to issue a statutory requirement notice. We carried out a random visit to Chesswood Lodge in November 2008 we found documentation which supported written evidence supplied by the provider that they had met the requirement made in the notice. We also found evidence that weekly random testing of hot water outlets is taking place and monthly testing of all outlets take place. At this visit we found evidence that random and monthly tests of hot water outlets throughout the premises has continued. The bathroom identified as being a risk to residents has been renovated and converted into a toilet with a hand wash basin. Information within the AQAA also stated that, The group employs a maintenance team to esnure regular maintenance is carried out to keep the home safe and well maintained. Checks on water temperatures, PAT testing, Legionnaire testing are carried out and recorded. The lift is maintained by an outside contractor . We also visited the kitchen area, the laundry, and several bathrooms. We noted that these areas have been maintained to a good state of cleanliness. There were no odours present. Where necessary appropriate aids and adaptations such as raised toilet seats and grab rails have been provided. Information supplied within the AQAA confirmed that policies and procedures are in place for staff to follow to ensure the risk of cross infections is reduced. We noted that a plastic bin was located in the laundry room for staff to discard used plastic gloves and aprons. However, the bin did not have a lid. We spoke to the manager and recommended that the bin is provided with an appropriate lid to help reduce the risk of cross infection. Information within the AQAA confirmed that, The home is kept clean and free from odours by domestic staff. A gardener maintains the garden on a regular basis. Care Homes for Older People Page 23 of 33 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. The numbers and skills mix of staff provide are sufficient to meet the current needs of residents. The provider has ensured residents are in safe hands at all times. All care staff who work at Chesswood Lodge have undergone approprate checks to ensure they are fit to work in a care home. Evidence: We looked through a selection of staff rotas. They demonstrated that between 8am and 8pm each day there are two care assistants on duty. The registered manager is included in this number and she works on shifts alongside care assitants. Each night there is one care assistant awake on duty and one care assistant asleep and on call in case of emergencies. Care staff are also expected to undertake laundry and cleaning duties. Care staff are also involved in preparing meals. We spoke to Mrs Constable and Mrs Shoai about staffing levels. We were informed that, if needed, addtional staff are provided to accompany residents to doctors or hospital appointments and other events that take place outside of the care home. We were advised that addtional staff will also be provided if a resident becomes more Care Homes for Older People Page 24 of 33 Evidence: dependent on a short term basis. If additional care is required over the longer term the manager will approach the local social services office in order to review the residents placement at Cheswood Lodge. Residents we spoke to confirmed they feel well cared for. 75 of residents who completed surveys confirmed staff are always available when they are needed. 25 of residents who returned surveys confirmed this is sometimes the case. One resident told us, I feel I worry a lot and feel they sometimes find it hard to cope with me. After speaking to residents and examining a selection of care records we concluded that there were sufficient staff on duty to meet the current care needs of residents. We looked through records of training that staff have received. They confirmed that staff had received mandatary training covering such areas as what to do in the event of fire, moving people safely and infection control. Records seen also demonstrated that further training planned included food hygiene and health and safety. We were advised by the manager that this would update training that staff had already received. We spoke to staff who were on duty at the time of our visit. They confirmed the training they had received. We looked through the records of two staff who have been appointed since our last inspection. They demonstrated that the provider had obtained appropriate information and documents about each person which confirmed they are fit to work in a care home before they started work. All surveys returned by staff confirmed that their employer had carried out checks, such as criminal records bureau checks and references, before they started work. Information provided in the AQAA confirmed that, We have a thorough recruitment process in place. All new staff are CRB or POVA checked before they start work. All straff have two references obtained for their files. All staff are given a handbook, a contract and a copy fo the GSCC Code. We also looked through records of training that staff have received. They confirmed that staff had received mandatary training covering such areas as first aid, food hygiene, infection control and the safe adminsitration of medication. All surveys returned by staff confirmed they had been given training which is relevent to their role, helps them understand and meet the needs of residents, and keeps them up to date with new ways of working. They also confirmed that induction training mostly covered the information they needed to know how to do the job when they started. Information supplied in the AQAA confirmed that, of the ten permanent care workers Care Homes for Older People Page 25 of 33 Evidence: employed to work at the care home, two had received structured induction training approved by Skills for Care. Five care workers have the National Vocational Qualification in Care, or in Health and Social care at Level 2 or above. This information also confirmed, All new staff undergo induction training. All staff undergo mandatory training and have access to outside training courses. Care Homes for Older People Page 26 of 33 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 provider has appointed a manager who has demonstrated they are fit to be in charge of Chesswood Lodge. The home has been run in the best interests of residents. The home does not involve itself with the personal finances of residents. The manager has not provided staff working in the home with appropriate supervision. In the main, the health, safety and welfare of residents and staff is fully promoted. Evidence: Mrs Jacqueline Constable has been appointed to the post of manager since our last visit. She has also been registered with us in accordance with the provisions of the Care Homes for Older People Page 27 of 33 Evidence: Care Standards Act 2000. Residents we spoke to during our visit confirmed they find Mrs Constable approachable. Information provided in the AQAA confirmed that, She has the Registered Managers Award and ASET Level 2 in Dementia Care. We looked through the minutes of the last staff meeting which took place in November 2008. This demonstrated that meetings are used by the management of the service to discuss the needs of residents with staff and also to discuss the day to day running of the home. Staff are also asked to discuss their views or ideas as well. Mrs Shoai showed us copies of satisfaction questionnaires which residents and their relatives are asked to complete. Mrs Shoai also confirmed that they are used to obtain their views of the care home. Mrs Shoai also demonstrated the care home is visited regularly by representatives of the registered provider in order to monitor the management of the care home and to ensure it has been run in the best interests of residents. Whilst recent reports of such visits were not available, Mrs Shoai confirmed they had been carried out. Mrs Shoai agreed to ensure reports are brought up to date and to provide copies for the manager to keep in the home. Mrs Constable has not ensured each member of staff is supervised regularly since her appointment. Mrs Constable confirmed that she understood that staff should be supervised but was unable to explain why this has not taken place. Mrs Shoai confirmed that all residents either manage their own financial affairs or have appointed family members or solicitors to act on their behalf. The home does not act as an appointee for handling the financial affairs of any resident. The premises have been well maintained, ensuring a safe environment in which residents can live and staff can work. The registered provider has supplied us with information in the AQAA that indicates equipment such as boilers, other gas installations and electrical equipment have been regularly serviced and maintained. Residents have told us that they are satisfied with the accommodation and services provided. According to training records staff have been provided training in such subjects as fire safety training, moving and handling and food hygiene. Following the incident where a resident was scalded we carried out a random Care Homes for Older People Page 28 of 33 Evidence: inspection in November 2008 to ensure the statutory requirement notice we had issued had been complied with. Our findings at the random inspection that the notice had been complied with in full. We recommended at that time that it would be considered good practice that the management of the home monitors hot water testing records to ensure they continue to take place. We found no evidence that demonstrated the manager had implemented our recommendation. Information supplied to us in the AQAA also confirmed that, Accidents, injuries and incidents are recorded and reviewed regularly . The boiler and heating system are regularly maintained and serviced. Legionella testing is carried out annually. The home has a comprehensive health and safety policy. Care Homes for Older People Page 29 of 33 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 30 of 33 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 1 33 26 Records of monthly visits 30/05/2009 made by representatives of the registered provider must be kept in the care home This will demonstrate the registered provider is monitoring the the day to day running of the care home to ensure it is being run in the best interests of residents 2 36 18 All staff must have regular, 30/05/2009 recorded supervision meetings at least six times a year with the manager This will ensure staff receive the support and guidance they need in order to be effective in their work 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 Care Homes for Older People Page 31 of 33 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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