Care Home: Cheverells

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What the care home does well People living at Cheverells say that they are made to feel "very welcome" from their very first day living at the home. Important information is obtained about people prior to agreeing to their moving to the home. This helps to reduce the risk of an inappropriate admission to the home and ensures that the team can meet people`s needs. Care plans are well structured around what each person wants from the team. The team of staff have good links with professionals, which helps to improve peoples` health. People who live at the home say that the staff are "very attentive" and "know what they are doing" because they are well trained. Their relatives are very satisfied with the care and also say that their relations are happy living there. People living at the home told us they are treated as individuals. The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. At the same time, they are confident about the way staff protect their property for them. Families and friends say that they are encouraged to visit whenever they wish to. The people living at the home get support to keep in touch with their families and friends if they need to. At the same time, the home plays an active part in the community. There is a good choice of appetising and well-balanced meals at Cheverells. People tell us that the choice is good and meals are "tasty" and are "always of good quality and plentiful". Cheverells is a spacious and comfortable place to live. At the same time, people who use wheelchairs or walking aids find it easy and safe to get around the home. The garden has plenty of seating and is at a raised level so that people can enjoy the flowers and fresh air. People living there say that they are encouraged to see it as their own home and that it is always clean and well maintained. Staff feel well supported and are encouraged to do training so that they care for people properly. What has improved since the last inspection? The providers sent us an improvement plan at our request and have significantly improved a number of areas that we had concerns about. People living and working in the home tell us that their views are listened to and their concerns, if they have any, are taken seriously and looked into by the provider. All care plans are up to date and reviewed regularly and ensure that peoples` changing needs are recorded. Communication between the staff team and management has improved. The providers have set out clear lines of authority so that people are clear about who is in charge. The providers and staff have done safeguarding training and now know the correct procedures to follow if an allegation or incidence of abuse occurs. What the care home could do better: People living in the home may have complex nutritional needs, which are not assessed. Using a recognised tool for assessment would ensure that staff are prompted to look into all aspects of the person`s needs so that there is a clear plan as to how these will be monitored. Staff responsible for giving out medicines need to be reminded about best practice outlined in Cheverell`s procedures to avoid putting people at risk of being given the wrong medication at night. People`s needs should be assessed in terms of occupation, interest and capabilities using an evidence based tool such as The `Pool Activity level instrument`. This will ensure that activities are person centred and appropriate for the individual. People need to have the right contact details for the Commission in the complaint procedure, so that if they wish to they can contact us. CARE HOMES FOR OLDER PEOPLE Cheverells Limers Lane Northam Bideford Devon EX39 2RG Lead Inspector Susan Taylor Unannounced Inspection 12:45 1st May 2008 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 Cheverells DS0000022173.V359675.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. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheverells Address Limers Lane Northam Bideford Devon EX39 2RG 01237 472783 NO FAX 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) Mr Philip Woods Mrs Gaynor Woods Mr Philip Woods Care Home 36 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (36), Old age, of places not falling within any other category (36), Physical disability over 65 years of age (36) Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th November 2007 Brief Description of the Service: Cheverells Care Home is registered to provide personal care for up to 36 men or women over the age of 65 years, some of whom may have a physical disability or mental health disorder. Cheverells is a large detached Victorian property with several purpose built extensions, situated just outside Bideford, with views across the River Torridge. The bedrooms are spacious, light and individually sized. With the exception of one room, all have en-suite facilities. Decoration and furnishings throughout the home are of a high standard. Communal areas are also spacious and include three sitting rooms, a dining room and a sun lounge. Externally the home is well maintained and sound. The garden is mature and beautifully kept; there is a pond with wild mallard ducks and a wooded area. An attractive chrome barrier surrounds the pond. The garden is accessible for residents to enjoy with several stair lifts giving access to all areas of the home. A ramped entrance has been built to further increase access to the home. The cost of care ranges from £294 to £390 per week depending on individual needs. Additional costs, not covered in the fees, include chiropody, hairdressing, and personal items such as toiletries and newspapers. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk Current information about the service, including CSCI reports, is available to prospective residents, relatives and others who may have an interest such as care managers. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was a key inspection of Cheverells under the ‘Inspecting for better lives’ arrangements. We were at the home with people for 8½ hours. The purpose for the inspection was to follow up legal requirements that had been made at the last inspection. The provider sent us an improvement plan and we wanted to find out whether there had been any progress with this. We looked at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We met ? people that live at Cheverells, ? staff Their comment are included in the report. As at May 2008, the fees ranged between £294 and £390 per week for personal care. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk People described Cheverells as being a “lovely home” and gave it “top marks” when asked how they would rate it. What the service does well: People living at Cheverells say that they are made to feel “very welcome” from their very first day living at the home. Important information is obtained about people prior to agreeing to their moving to the home. This helps to reduce the risk of an inappropriate admission to the home and ensures that the team can meet people’s needs. Care plans are well structured around what each person wants from the team. The team of staff have good links with professionals, which helps to improve peoples’ health. People who live at the home say that the staff are very attentive and “know what they are doing” because they are well trained. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 6 Their relatives are very satisfied with the care and also say that their relations are happy living there. People living at the home told us they are treated as individuals. The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. At the same time, they are confident about the way staff protect their property for them. Families and friends say that they are encouraged to visit whenever they wish to. The people living at the home get support to keep in touch with their families and friends if they need to. At the same time, the home plays an active part in the community. There is a good choice of appetising and well-balanced meals at Cheverells. People tell us that the choice is good and meals are “tasty” and are “always of good quality and plentiful. Cheverells is a spacious and comfortable place to live. At the same time, people who use wheelchairs or walking aids find it easy and safe to get around the home. The garden has plenty of seating and is at a raised level so that people can enjoy the flowers and fresh air. People living there say that they are encouraged to see it as their own home and that it is always clean and well maintained. Staff feel well supported and are encouraged to do training so that they care for people properly. What has improved since the last inspection? The providers sent us an improvement plan at our request and have significantly improved a number of areas that we had concerns about. People living and working in the home tell us that their views are listened to and their concerns, if they have any, are taken seriously and looked into by the provider. All care plans are up to date and reviewed regularly and ensure that peoples’ changing needs are recorded. Communication between the staff team and management has improved. The providers have set out clear lines of authority so that people are clear about who is in charge. The providers and staff have done safeguarding training and now know the correct procedures to follow if an allegation or incidence of abuse occurs. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. People are supported to be fully involved in the assessment process and information is gathered from a range of sources. This could be improved further to ensure that people’s needs are assessed using a recognised tool to identify risks with nutrition so that there is a clear plan as to how this will be monitored. The home does not offer intermediate care; therefore no judgement has been made about this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home and relatives told us that the home provides sufficient information for them to make decisions about whether to live at the Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 10 home or not. We saw that everyone had a copy of the ‘service users guide’ in their room. We spoke to a number of people that live at the home who told us that Cheveralls meets their needs. Visitors told us that the home “is the nicest we’ve seen.” They also told us that they were “always made very welcome” when they came into the home. The provider told us that people are assessed by herself or the deputy manager who go to visit the person in their current setting to make an assessment. The pre admission form seen included information about their current abilities, medication, next of kin and equipment required. We examined four care files. A thorough assessment of needs had been completed with people and their relatives when they moved into the home. Additionally, information about the individual had also been obtained from social services if the care package had been commissioned by them. Assessments completed by the provider established what risks, if any, an individual had in terms of about their tissue viability and falling. One person had complex nutritional needs and records showed that they were losing weight despite extra supplements. These needs had not been assessed. A tool such as the ‘Malnutrition Universal Screening Tool’ (available at from http:/www.bapen.org.uk/must_tool.html) can be used for this purpose and a recommendation is made. This would ensure that staff are prompted to look into all aspects of the person’s needs so that there is a clear plan as to how these will be monitored. We spoke to the relatives of someone that was in the process of moving into the home. They told us that the assessment of their mother had been “sensitive”. They said that the provider “was very kind” and had “focussed on her and held her attention” and helped their mother feel completely at ease. The bedroom she was moving into had been decorated and a new radiator guard fitted. The relatives told us that the provider had been “accommodating and helpful” when they needed to bring her furniture in ahead of the moving in date. The provider verified that intermediate care is currently not provided at Cheveralls. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 11 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. People that live at Cheveralls receive effective personal and healthcare support that is person centred and is based upon the rights of dignity, equality, fairness, autonomy and respect. Improvement was seen with the way medication is handled and ensures that people are are given the right medication at the right time. Staff responsible for giving out medicines need to be reminded about best practice outlined in the procedure to avoid putting people at risk of being given the wrong medication at night. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care files of four people living in the home. All were complete and had been regularly reviewed and there was a significant improvement since the last inspection. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 12 Certain files, which contained records of the individual person’s progress and personal details such as their next of kin, visits by district nurses are kept in the office at the home. Other files are kept in the rooms of the people who live in the home. There was a front sheet, which included the name by which the person liked to be referred, a photograph of the person and details of their next of kin. Within the file was a personal history. These gave details of the person, outlining important parts of their life history giving identity to that person. These were written in consultation with the person who lived at the home and often their relatives or next of kin. Relatives of a person that was in the process of moving in, told us that they had been asked to do a social history about their mother to help the staff get to know her. Care planning in the home is person centred, with phrases such as ‘I like to…’ filled in about the individual. Information sent to us by the provider told us that staff ensure that people are giving choice in their day-to-day lives, for example what to wear, stay in bed longer and have a later breakfast. The plans cover daily routine such as those relating to going to bed, waking, oral care, toileting, dressing and any special needs the person may have. Reviews had taken place with the individual concerned and/or their relative had been signed by them as having been present. We examined three care files and saw that the needs of people living in the home are translated into detailed care plans that staff and the individuals themselves have access to. People’s weight was being monitored and risk assessments had been completed and regularly reviewed. We tracked care for the individuals that had a range of health and social care needs including diabetes, dementia and immobility. Advice had been sought from healthcare professionals such as the diabetic nurse and tissue viability nurse specialists. Where needed, specialist equipment had been obtained such as a pressure relieving mattress and cushion. The person who was had mobility needs told us that they were well cared for and needed a lot of attention because they needed to change their position regularly. We saw that the person was lying on a pressure relieving mattress that was fully operational. Daily records demonstrated that the person was seen regularly by the district nursing team. Similarly, the person had also been visited regularly by their GP to monitor their healthcare needs. We tracked the care of a person with dementia, who was being treated for an infection as detailed in their care plan. Daily records demonstrated that the GP had visited this person regularly. Antibiotics and pain relief that had been prescribed by the GP was given as prescribed. Advice had also been sought from a specialist practitioner to help improve the individual’s continence. Staff told us that they were working to the guidance given. Training records Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 13 verified that all of the care staff had attended courses on dementia awareness and continence care. The needs of a person with diabetes were tracked. A care plan had been written outlining how the person would be monitored, the type of diet they needed and medication they were prescribed. At lunchtime the individual concerned told us that they always had a meal that was suitable for them, reduced sugar and low fat. They told us that their weight was regular monitored and we saw a record that had been kept in the individuals file. Daily records documented when the person had attended the eye clinic at the local hospital for regular screening, and correspondence about this was also examined. All of the people we spoke to were completely satisfied with the health and personal care they receive. Particular examples are given such as prompt attention to dental care and contacting GP in the event of ill health. Similarly, at the inspection people told us that staff “always knocked” before entering their rooms and treated them as individuals. The home uses a monitored dosage system. Senior staff are responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and we tracked medication given to four people. Records accurately reflected medication having been given as prescribed by the GP. One person’s comments were typical of those we case tracked, they said [I] “get my medicines given to me”. All medication was kept in a secure place. We observed medication being given to people after lunch and the evening meal. This was done safely and records were completed appropriately after each person had taken their medication. Particular aspect of the management of medicines had improved. Risk assessments were in place for people that self medicate, and had been reviewed since the last inspection. We saw records, which demonstrated that the temperature of the fridge was regularly checked. Creams or ointments that people had or were being treated with were recorded on the Marrs sheet with the directions of the prescriber and an expiry date recorded. However, before we left we observed medicines being put into pots, with the individuals’ name on it, ready for staff on the night shift to give out. The member of staff doing this said that “some people like to have their medicines before 9pm others like it after”. We discussed the practice of ‘secondary dispensing’ with the member of staff and told them that this was unsafe. If the care worker giving the medicines does not have the container with the label they cannot be sure that each person receives the right dose of the right medicine at the right time, as prescribed. Additionally, they do not have access to information about how the medicine should be taken that is on the container. Best practice guidance is available on our website at: Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 14 http:/www.csci.org.uk/professional/default.aspx. We discussed our observations with the provider who verified that the normal procedure had not been followed and would take this up with the individual concerned through the supervision process. The home uses controlled drugs, which are managed satisfactorily, and a random check was undertaken. Other care staff that were spoke to told us that medicines are only adminstered by people that are trained to do this. We examined a random selection of 4 staff files, 2 of which were for longer serving employees that had certificates demonstrating this. Therefore, the people responsible for giving out medication had received training. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Routines and activities are flexible for people and they are listened to regarding the choice of daily activity. These could be individualized further to take account of the diverse needs of people living there to ensure that everyone leads a full and stimulating life. People are encouraged to maintain contact with friends and family in the community, which demonstrates a commitment to the principles of inclusion. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On arrival at the home we saw a poster entitled ‘Tell us how you want the home to run’ advertising a meeting on 6th May 2008 to which relatives were also invited to attend. We were shown the monthly newsletter, which had been given to the relatives of a person moving into the home. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 16 Information sent to us by the home explained that the programme of activities available is varied and no extra charge is made for outings for example. We tracked the outcomes of care for four people and spoke to them and their families about activities and outings that are available at the home. People made comments like “there are lots of activities, some I don’t like, but there is always an outing every Friday”. A person who had had a stroke told us that they couldn’t do very much due to their condition, but did “join in the exercise group” and enjoyed it. We spent time in the lounges observing how staff interacted with people. During the period of observation, activities or stimulation for these people was still limited and people were seen wandering around the home unoccupied and confused on occasions. When staff did engaged with people they demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. Activities were group based and did not always reflect the level of ability that the person had given the stage of their dementia. To illustrate this point, some people might be more responsive to sensory activities such as painting or aromatherapy. Alternatively other people might be more responsive to cognitively based activities, such as a reminiscence quiz. We also tracked the outcomes for a person with a dementia related illness. We looked at the individual’s care file, which had background information about the person obtained from their family about their life at work, family, friends and interests. Information from the provider [AQAA] tells us that more structured activities will be introduced to meet people’s needs, which will include reminiscence sessions and painting and drawing. This should be based on assessment of their needs in terms of occupation, interest and capabilities using evidence-based tool such as The ‘Pool Activity level instrument’. This will ensure that activities are person centred and appropriate for the individual. The home had an ‘open’ feel, with visitors coming and going to see people in the home. Relatives that we met told us that they are ‘always welcomed’ and know who to talk to if they should have any queries. The provider told us that mealtimes are seen as a social event and therefore people living in the home are encouraged to join everyone in the dining room at mealtimes. People we spoke to made comments like (the meals are) really good and “tasty”. We saw lunch and the evening meal served during the inspection, which were well balanced and appetising. Information sent to us by the provider tells us that changes have been made to the tea time menu as a result of listening to people living in the home since the last inspection. We saw at least two different choices being served. The catering staff explained that they have written details of individuals’ likes and dislikes and can plan menus around these. We were told that special diets such as low fat/sugar had been made for people with diabetes. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 17 Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good Cheverall’s arrangements for the protection of vulnerable adults, including dealing with complaints have significantly improved and ensure that people are protected and able to voice their concerns. Minor amendments are required to the complaint procedure to ensure that people have up to date contact information about CSCI. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, an improvement plan was agreed with the provider about what they needed to do to improve the way complaints are handled in the home. We read the ‘Feedback’ procedure that had been written as a result of this. The procedure enables people to make complaints or comments about the service if they wish to. The contact details for the Commission are contained in the document and are now incorrect. The Commission has a regional contact team and the address and contact telephone numbers need to be updated in the document to reflect this. Information that the provider sent to the Commission verified that one complaint had been received and resolved within 28 days. Since the last Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 19 inspection, the Commission has not received any complaints about the service. We tracked the outcomes of care for four people and saw that all of them had a copy of the statement of purpose and service user’s guide, which contained information about the complaint procedure. People we spoke to, including their relatives verified that they were listened to and that this had “improved”. On arrival at the home we saw a poster entitled ‘Tell us how you want the home to run’ advertising a meeting on 6th May 2008 to which relatives were also invited to attend. We were shown the monthly newsletter, which had been given to the relatives of a person moving into the home. We spoke to the providers about these changes and they told us that they had learnt to view complaints as a positive way of monitoring the quality of the service. This demonstrates that the providers have taken on board the feedback we gave them and are actively seeking it from people that live in the home and others that may have an interest. We saw a copy of the ‘Alerters guide’. The home also had a whistle blowing policy, which all of the staff we spoke to understand. Kind and caring interactions were observed throughout the day between staff and people living in the home. Staff engaged positively with people who had dementia and demonstrated genuine warmth when engaging those individuals. A relative told us that the staff were “kind and caring”. Another visitor commented that their relative was contented. Information sent by the provider told us that fourteen out of twenty seven staff hold an NVQ in care [51 ], part of which is about safeguarding people. A further four staff are in the process of doing the award [15 ]. Additionally, staff told us that policies and procedures are discussed with them. We looked at training records and saw that ‘Safeguarding Adults’ training had been provided for staff on 7th March 2008. Information sent to us by the provider [AQAA] verified that no safeguarding or POVA referrals had been made since the last inspection. We discussed these procedures with the provider and based on what they told us and had written in the improvement plan, completely understand Safeguarding procedures. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is excellent. The living environment is appropriate for the particular lifestyle and needs of people living there and is homely, clean, safe and comfortable, well maintained and reflects individual tastes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We toured the premises and saw that radiator guards had been fitted throughout the building since the last inspection. Fire exits were clear and accessible. All the bedrooms were inspected and found to be clean, individualised and comfortably furnished. People living in the home told us that there is always a housekeeper on duty. All of the toilets and bathrooms Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 21 had locks on the doors. Communal areas were spacious, comfortable and homely. Maintenance certificates were seen for assisted baths, electrical installation, central heating and fire alarm systems. We spoke to the relatives of someone that was in the process of moving into the home. The bedroom she was moving into had been decorated and a new radiator guard fitted. Additionally, it was spacious and had a picture window overlooking a raised flower bed with a bird table. The relatives told us that their mother would love sitting and watching the birds so the room was “just right for her”. Additionally, they told us that the provider had been “accommodating and helpful” when they needed to bring her furniture in ahead of the moving in date and were visiting that day to deliver more personal items and help get her room ready for her arrival. People we spoke to including relatives verified that the home is kept fresh and clean. Information sent to the Commission by the provider verified that an audit using the department of health guidance had been carried out and we saw a record of this. Excellent practice was observed during the inspection. All of the staff we spoke to had received training about the prevention of infection and management of infection control. Information sent to us by the provider verified that thirty staff have attended this training. Hand towels and soap dispensers were seen in wcs, bathrooms and bedrooms. Good hand washing practices were observed as staff were seen to deliver care to people. The laundry was clean and well organised. We observed good infection control measures being followed when staff were dealing with soiled linen. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 22 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. Recruitment practices at Cheveralls protect the people that live there. The home has a training and development culture that ensures competent and knowledgeable staff care for the people that live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home described the team as kind and “very attentive staff”. We looked at the duty rota that accurately reflected the number and skill mix of staff on duty during the inspection; six care staff in the morning and five during the afternoon and into the evening. Additional staff were on duty at busier times of the day. At night there was two waking staff. The registered providers live in an adjacent house and are contactable by telephone. They also work alongside staff during the day. We interviewed four staff and they all told us that they have time to spend with people and do not ever feel rushed in what they do. We observed good outcomes of care for people living in the home. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 23 There is a diverse staff team at Cheveralls, with a gender mix that is consistent with the people living there. We examined four staff files. Appropriate preemployment checks had been undertaken - written references [two] had been obtained including criminal records bureau certificates and POVA. Additionally, for some employees the provider had obtained certificates of good character from their country of origin and work permit. We spoke to staff about their experience and training opportunities in the home. All of the staff verified that they had completed induction training. We saw certificates on individual files demonstrating that recent courses completed included manual handling, safeguarding, fire and health and hygiene training. Care staff verified that training was regularly offered to them. Information sent by the provider told us that fourteen out of twenty seven staff hold an NVQ in care [51 ]. A further four staff are in the process of doing the award [15 ]. The provider also verified that the turnover of staff had been low. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 24 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 & 38 Quality in this outcome area is good. People living and working at the home now benefit from a clear managerial structure and lines of accountability. Quality assurance systems have significantly improved and the views of people living, visiting or working at the home are respected and acted upon in a proactive way. Health and safety is promoted and ensures that people living and working in the home are protected. This judgement has been made using available evidence including a visit to this service. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 25 EVIDENCE: Mr and Mrs Woods jointly own the home. Mr Woods is the registered manager and has the Registered Manager’s Award. He undertakes a management and administration role in the home. He is responsible for staff recruitment, staff supervision, finances and maintenance. Mrs Woods takes a “hands on” role and is responsible for the day-to-day running of the home. She is not included in the numbers as there are sufficient staff on duty. People we spoke to felt that Mr and Mrs Woods are “friendly”, “highly skilled” and run the home efficiently to high standards. Since the last inspection, Mr and Mrs Woods have established clear lines of accountability. Staff told us that communication is much better and that they are clear about who is in charge of the home. The home carried out an annual questionnaire in June 2007 to obtain people’s views about the home. Positive comments were obtained on the facilities, food, accommodation and staff. The owners addressed any negative issues. A monthly newsletter, which includes a list of forthcoming activities for the month, is given to every person living in the home and their relatives. This was put in place as a result of the providers listening to feedback from the people that live at Cheveralls. The provider gave the Commission a good picture of the current situation at Cheveralls, in a document entitled AQAA (Annual Quality Assurance Assessment). They told us that they intend to use this to monitor Quality Assurance at the home throughout the year. We were told that no monies were held on behalf of any person living at the home. Information sent to us by the providers verified that all service contracts and maintenance of equipment is carried out to manufacturers and health and safety guidelines. Records demonstrated that fire safety equipment is serviced and also checked regularly. Comprehensive Health & Safety policies and procedures were seen. We toured the premises and saw that radiator guards had been fitted throughout the building since the last inspection. The staff we spoke to verified that they had had recent moving and handling training. We saw certificates showing that hoists in use were regularly serviced every six months. People told us that they felt safe at Cheveralls. Electrical appliances had been checked to ensure conformity and safety. Staff on duty had First Aid qualifications. First Aid boxes were accessible to staff. A fire risk assessment and strategy in the event of fire was seen. All of the staff that we spoke to had received training in the last twelve months. We examined the fire log and established that the fire alarm system, emergency lighting and extinguishers had been regularly Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 26 checked and properly maintained by an outside company. Induction records for new staff were seen and demonstrated that they are supported, trained and supervised until they are considered competent in all areas of care. Accident records were examined, were well kept and demonstrated that prompt and appropriate action had been taken. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 27 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 4 x x x x x x 3 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 N/A x x 3 Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The nutritional needs of people living in the home should be known by being properly assessed with a tool such as the ‘Malnutrition Universal Screening Tool’ (available at www.bapen.org.uk). People living in the home need to be confident that staff responsible for giving out medicines always follow Cheverell’s procedures so that they receive the right medication at the right time. The diverse needs of people are taken into account when organising individual and group activities so that everyone leads a full and stimulating life. For example, use an assessment tool like the ‘Pool Activity level instrument’ to establish exactly what individuals’ are able to do and indentify suitable activities accordingly. 2. OP9 3. OP12 Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 29 4. OP16 People need to have the right contact details for the Commission in the complaint procedure, so that if they wish to they can contact us. The procedure needs minor amendment. Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Cheverells DS0000022173.V359675.R01.S.doc Version 5.2 Page 31 - 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. 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