Care Home: Chiltern Cheshire Home

What the care home does well Prospective service user`s wishes and the support they need to remain independent are identified with them before they move to the home. There is a comprehensive multidisciplinary assessment and service users are encouraged to visit and stay at the home before moving permanently. Service users are actively involved in decisions about their lives whether at organisational, local or personal level, affording them dignity and influence. The atmosphere in the home is very relaxed and service users are able to decide how they spend their day and to mix with others if they wish. Care staff were observed to respect service user`s wishes. Service users receive personal care in the way they prefer. Their medication and health care needs are met, promoting their health and independence. There is good support from the local Primary Care Trust and service users have access to specialist members of the team, including physiotherapy, speech and language therapy, continence adviser and district nurses. They can access optical services and dentistry. Service users are respected as individuals and helped to be a part of the local community. There is a wide range of activities in the home and service users are supported by a large group of volunteers who help with activities, drive cars and minibuses and support a wide range of external activities. There are no time limits and service users can go out when they choose, including to evening shows. People who use the service are confident that their views are listened to and acted upon. They are protected by the safeguarding practices in place and are supported to manage their money where they are able. We have not received any concerns about the service and have not been notified of any safeguarding issues which have been referred to the local authority which is the lead agency in this matter. People who live here are encouraged to regard it as their home. They have access to all parts of the building and privacy in their own rooms, promoting their independence and autonomy. The home is homely and residents are encouraged to personalise their rooms and many had chosen to do so. The home is adapted to be accessible to people with disabilities. There is a well motivated staff team who have received training to undertake their support role. The recruitment procedures are thorough protecting service users from unsuitable carers. The home is well managed. It is part of a national organisation and the ethos is to support service users to be as independent as possible. The manager is experienced and sets a high standard. What has improved since the last inspection? The home has addressed the recommendations of the last report. There has been a programme of ongoing redecoration.The home has promoted equality and disability training for all staff. This training is also available to the volunteers who give their time to support service users. What the care home could do better: It is recommended that service users` support plans are kept together and not over several files in different locations. The infection control policies and practices should be reviewed to protect service users from potential infection. The home should review its policies and procedures to ensure that they are in line with the latest guidance from the Department of Health. They should consider the way in which soiled laundry is dealt with and should consider the provision of alcohol hand gel for the use of staff and others. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chiltern Cheshire Home Packhorse Road Gerrards Cross Bucks SL9 8JT     The quality rating for this care home is:   three star excellent 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: Chris Sidwell     Date: 0 8 0 5 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 Adults (18-65 years) 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 Adults (18-65 years) Page 2 of 27 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 Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Chiltern Cheshire Home Packhorse Road Gerrards Cross Bucks SL9 8JT 01753480950 01753480951 hanne.abildgaard@lc-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leonard Cheshire Disability The registered provider is responsible for running the service care home 22 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 22 The maximum number of service users who can be accommodated is: 22 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: Physical disability - PD Date of last inspection Brief description of the care home Chiltern Cheshire is a purpose built home situated in Gerrards Cross. The home provides care for 22 adults who have a physical disability. Personal care and support is provided for both men and women between the ages of 18 and 65 yrs old. The home is located in close proximity to the town centre where all local facilities can be found. Service users utilise these services and the facilities of the nearby towns of High Wycombe, Slough and Uxbridge. Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was conducted over three days and included a review of the information we hold about the service and an unannounced visit to the home of six hours. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment. Questionnaires were sent to the home for distribution to residents, families and staff. Residents were spoken to on the day of the unannounced visit. Discussions took place with the manager, care and ancillary staff. Care practice was observed and the care of a small number of residents was followed Care Homes for Adults (18-65 years) Page 6 of 27 through in detail. A tour of the building and examination of records was also undertaken. The homes approach to equality and diversity was considered throughout. What the care home does well: What has improved since the last inspection? The home has addressed the recommendations of the last report. There has been a programme of ongoing redecoration. Care Homes for Adults (18-65 years) Page 8 of 27 The home has promoted equality and disability training for all staff. This training is also available to the volunteers who give their time to support service users. 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 Adults (18-65 years) Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 27 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Prospective service users wishes and the support they need to remain independent are identified with them before they move to the home, to ensure that they can be met. Evidence: Prospective service users needs and wishes are discussed with them before they move to the home. A full multi professional assessment is undertaken and the home seeks the care managers assessment. Prospective service users are invited to visit the home and to stay for varying periods of time before they decide whether they wish to move to the home. One service user who was staying for a period of respite said that the home could not do enough for him. He looked forward to his stays. He felt that the staff understood his needs and wishes and supported his independence. The approach to the assessment is to focus on the abilities of people and to support their independence. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are actively involved in decisions about their lives whether at organisational, local or personal level, affording them dignity and influence. Evidence: The ethos of the organisation is to involve service users at all levels in decision making. There is a service users network at organisational level and a service users support team. The organisation is currently developing a new strategy to deliver its services for disabled people. The review outline shows that service users are involved at all levels. There is a an active home residents committee and service users have access and make use of local advocacy groups. Four residents were spoken to and their support plans were reviewed. They all said that they were involved in all decisions about their support and daily lives. These were recorded in their plans. It was clear that service users are involved in drawing up their support plan and had signed them where they were able to so. Their cultural and faith needs were addressed as well as support needs arising from their disability. It was evident that service users Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: lead active lives and there were risk assessments in place to support this. Service users support plans were spread over a number of folders and it is recommended that this is reviewed as some risk assessments were difficult to find. Service users communication styles were recorded. Service users are involved in interviewing new staff and one service user had the questions she wished to ask programmed into her electronic speaking aid. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home respects service users individuality, dignity and privacy promoting their independence and wellbeing. Evidence: People living in the home live an active lifestyle. They are supported to maintain links with the local community and can attend college if they wish. They use local hairdressing and opticians and are supported to shop independently if they wish. There is an active local volunteer support group who support service users in a variety of ways including trips to the theatre. There are no time limits and people are able to come and go as they please and frequently go to evening shows. There are two activities coordinators who facilitate a daily programme of in house activities. There is a large well equipped activities room. Service users were engaged in cooking at a specially designed cooking station, painting, gardening and using their computers. One Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: lady was making jam, another painting and one gentleman was studying for a maths qualification with the Open University. Specialist maths software and chess software had been installed on his computer. A local college had donated several computers to the home and was maintaining them. Care staff and service users said that they were supported to remain in contact with their families. Visitors are welcome at any time and service users are able to see them in their rooms or in any of the quiet communal areas. service users have keys to their rooms if they wish. Service users said that they enjoyed the food. There is varied menu and service users have input to the content of the menus and have a choice at most meals. Lunch time was seen to be a sociable occasion and carers were supporting those who needed assistance discretely. The chef knows service users well and cooks special diets if they wish or need them for health reasons. Meals times are flexible and meals can be served at different times if service users are out. Meals to meet service users faith and cultural wishes are available. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Service users receive personal care in the way they prefer. Their medication and health care needs are met, promoting their health and independence. Evidence: Service users personal care is given in line with their preferences. All care is given in private. Service users may express a preference for a carer of the same gender if they would prefer. The home is adapted to meet the needs of people with disabilities. Service users are supported to look after their appearance and choose the clothing and hairstyle that they wish. There is a key worker system in place. Key workers help residents manage their health care needs. The home has a physiotherapist who works with service users on a regular basis. Other members of the local primary health care team , such as dietitian, speech therapist, occupational therapist, district nurse and continence adviser also visit residents as needed. Service users are registered with the local general practitioner and there is evidence that service users access routine health screening services such as mammography when appropriate. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: There are medication policies and procedures in place. Service users are encouraged to manage their own medication if they wish. Four people were self medicating at the time of the unannounced visit. Medication records are good and controlled drugs are stored and administered correctly. Medication storage is satisfactory. Staff who administer medication are trained to do so and the medication management in the home is audited on a regular basis, by the pharmacist who supplies the home. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. People who use the service are confident that their views are listened to and acted upon. They are protected by the safeguarding practices in place and are supported to manage their money where they are able. Evidence: There are complaints and safeguarding policies and procedures in place. These are clearly displayed. The organization supports service users to make complaints if they need. There are also local advocacy services available and leaflets are freely available in the entrance hall. The service users spoken to said that they knew how to make a complaint although said that they had not had occasion to do so. One said I like it here, people listen to what I say. The homes records showed that no complaints have been received and no safeguarding allegations have been made, since the last inspection. The training records showed that staff have had training in safeguarding older people. The manager has registered for the local authority safeguarding training course. Staff were aware of the whistle blowing policies. Restraint policies are in place although no one is subject to restraint at the moment. Most service users were managing their own money and have lockable storage in their rooms. Care Homes for Adults (18-65 years) Page 18 of 27 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here are encouraged to regard it as their home. They have access to all parts of the building and privacy in their own rooms, promoting their independence and autonomy. The infection control policies and practices should be reviewed to protect service users from potential infection. Evidence: The home is purpose built and people with disabilities have access to all areas. The bathrooms and toilets are adapted to enable service users to use them with or without help. Service users are encouraged to personalise their rooms and most had chosen to do so. Their rooms clearly reflected their personalities and hobbies. Service users have free access throughout the home and have their own keys and front door swipe card. The home was clean and tidy on the day of the unannounced visit and there were no offensive odours. There are infection control policies and procedures in place. The training records show that staff have received infection control training. Staff do not wear a uniform to promote the atmosphere of a home rather than an institution. They wear protective clothing when giving personal care and serving food. There is soap and paper towels in service users rooms for the use of staff and visiting professionals. The home does not use alcohol hand gel, which should be considered. The laundry was Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: clean and tidy. Soiled laundry is segregated and washing machines have disinfection programmes. Soiled laundry is not however segregated in red bags with alginate stitching, which can be put directly into the washing machine ,obviating the need to handle the laundry. This should be considered. Care Homes for Adults (18-65 years) Page 20 of 27 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here are supported by carers who are well trained and respect service users as individuals. Evidence: There is a well trained team of carers who respect service users and endeavour to promote their independence. The staffing levels are good, with seven to nine carers on duty in the mornings and five to six in the evenings. The training records were in good order and showed that staff training in safe working practices was up to date. The manager is encouraging service users to participate in staff training by describing how their disability affects their everyday life. This is good practice. Fifteen carers hold the National Vocational Qualifications in Care at Level 2 or above and a further six are registering to undertake the course. This meets the standard that 50 of staff hold this qualification. Three recruitment files of staff who had started with the home since the last inspection were checked. All had application forms and interview records. The files showed that checks as to the staff members identity had been undertaken and work permits were in place where necessary. References and Criminal Records Bureau disclosures had been sought before the person started work. Service users are involved in interviewing Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: potential staff members. This is good practice. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the interests of the service users. Evidence: The service manager is experienced and holds the National Vocational Qualifications in Management and Care at Level 4. She continues to update her knowledge and has recently undertaken training to further her understanding of the Mental Capacity Act and the Deprivation of Liberty regulations. Staff and service users spoken to said that she was approachable and set high standards. There is a quality assurance programme in place. Annual staff and service users satisfaction questionnaires are undertaken and action plans are agreed. There is an ongoing programme of audit, including medication, service users support plans and recruitment files. The regional manager completes some audits and undertakes the quality assurance visits required by Regulation 26 of the Care Homes Regulations 2001. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: There is a health and safety committee which includes a service user. This meets regularly and records are kept. Regular safety checks of fire procedures are carried out. Hot water temperatures are checked regularly as are wheelchairs and bed rails. The annual quality assurance self assessment showed that maintenance schedules were up to date. Staff have had training in safe working practices. Accidents and injuries are recorded and the appropriate notifications are made. Care Homes for Adults (18-65 years) Page 24 of 27 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 Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 It is recommended that service users support plans are kept together and not over several files in different locations. The organisation and home should review the infection control policies and procedures to ensure that they are in line with the Department of Healths guidelines and should consider the provision of alcohol hand gel for the use of staff. They should also consider using red bags with alginate stitching, which can be put directly into the washing machine, obviating the need to handle the laundry. 2 30 Care Homes for Adults (18-65 years) Page 26 of 27 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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