Care Home: Chippings

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What the care home does well The service provides a good standard of care and support for the residents who live in the home. Residents confirmed this during conversation and the residents with non-verbal communication were able to sign and gesture their feelings. Four staff had been attending a Makaton sign language training day during the first day of the inspection and were observed communicating with residents using these signs. The standard of accommodation is good providing residents with ample communal space, and individual bedrooms, which have been decorated to a high standard. The interaction between residents and staff is positive and residents were confident in their manner and appeared relaxed in a homely environment. All staff addressed residents in a polite and respectful way. Individual programmes of activities and leisure are well designed with input from residents to meet individual and collective needs. Family and friendship links are maintained. Staff recruitment and development are based on the needs and the safety of the residents. The home is well managed by an experienced manager who has a good understanding of the need of the people he is caring for. He is well supported by a deputy manager and the provider. The home is managed in the best interests of the residents and it also promotes the health, safety and welfare of the residents and staff. What has improved since the last inspection? The statement of purpose and service user guide have been updated and now includes all the information required at the last inspection. The local pharmacy that supplies medication to the home provided a qualified pharmacist to undertake medication training in the home. The abuse awareness policy has been revised. A COSHH risk assessment, and an infection control risk assessment are now in place for the specific requirements made at the last inspection. All staff have a CRB (Criminal Records Bureau) disclosure in place and a POVA first check is undertaken prior to staff commencing employment. Written references are in place and an employment history obtained on the application forms. A review of staff training has taken place and staff were attending a Makaton training session on the first day of the inspection. What the care home could do better: There are no requirements as an outcome of this inspection. CARE HOME ADULTS 18-65 Chippings Chippings 28 Russells Crescent Horley Surrey RH6 7DN Lead Inspector Mary Williamson Unannounced Inspection 15th November 2007 10:30 Chippings DS0000013601.V352123.R01.S.doc Version 5.2 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 Chippings DS0000013601.V352123.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 Adults 18-65. 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. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chippings Address Chippings 28 Russells Crescent Horley Surrey RH6 7DN 01293 775350 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) chippings@gccare.co.uk Gresham Care Timothy Hurst Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th June 2007 Brief Description of the Service: The Chippings is a detached property located in a residential area in Horley, Surrey and provides accommodation for six service users with a learning disability. The property is close to public amenities and accommodation is on two floors accessed by stairs. The facilities on offer include six single bedrooms, lounge, a dining area, kitchen, bathrooms, toilets, showers, utility room and a sensory room. The home has a large garden that is private, secure and easily accessible. A sturdy climbing frame and small summerhouse are available for use in the garden. Limited private parking is available to the front of the property. As at 15th November 2007 the fee levels ranged from £961.51 per week to £2,546 per week and were based on individual assessments. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a site visit of a key inspection and was unannounced. Mary Williamson who is a Regulation Inspector undertook the inspection. The Registered Manager Timothy Hurst was present throughout the inspection and the Responsible Individual Mrs Beverly Winchester visited the home during the inspection. A tour of the premises was undertaken. Records relating to the care of the residents and the management of the home were examined, for example needs assessments, care plans, which included diverse needs of residents, medication recording charts, staff employment files and health and safety documents. It was possible to meet and talk with two of the residents in the home and the deputy manager who was also on duty. The inspector returned to the home on 19th November for a second visit to meet with more residents who were attending college during the first visit, to gain feedback about the home and the lifestyle they experience. The second visit was also an opportunity to meet with staff who were attending a training day during the first visit, and gain some feedback about their experiences of working in the home. The manager had completed an AQAA (Annual Quality Assurance Assessment), which was sent to The Commission for Social Care Inspection prior to the inspection. The complaints procedure and the abuse awareness procedure were seen and there have been no complaints since the last inspection. The Commission for Social Care Inspection would like to thank the residents and the staff team for their assistance and hospitality during the inspection process. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The statement of purpose and service user guide have been updated and now includes all the information required at the last inspection. The local pharmacy that supplies medication to the home provided a qualified pharmacist to undertake medication training in the home. The abuse awareness policy has been revised. A COSHH risk assessment, and an infection control risk assessment are now in place for the specific requirements made at the last inspection. All staff have a CRB (Criminal Records Bureau) disclosure in place and a POVA first check is undertaken prior to staff commencing employment. Written references are in place and an employment history obtained on the application forms. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 7 A review of staff training has taken place and staff were attending a Makaton training session on the first day of the inspection. 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. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives have access to appropriate information regarding the home. All prospective residents have a needs assessment undertaken, although there has not been an admission to the home for over three years. Contracts of occupancy are in place. EVIDENCE: Since the last inspection the statement of purpose and residents guide have been updated. These documents are available to the residents and their relatives for information, which are also available in symbol format. The manager stated that staff support the residents to help them understand the content of these documents. All the residents have a needs assessment in place. These assessments were undertaken prior to admission in order to establish if specific needs of individual residents can be met. The residents living at The Chippings have been living there for several years and the last person to be admitted was over three years ago. Three needs assessments were randomly sampled and are very detailed and informative. They are supported by various reports from other health care professionals. The care managers and home staff undertake a review of care needs annually. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 10 Contracts of occupancy are in place. These include the room to be occupied, the care offered, and the fees paid. Contracts are also available in symbol format and these have been signed by the residents. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s personal goals and needs are reflected in well-documented care plans, which also include risk assessments. All residents are encouraged to participate in the decision making, and the daily routine of the home. EVIDENCE: Individual care plans are in place and three of these were sampled during the inspection. Care plans are written on the basis of the needs assessment, input from residents and their families, and information obtained from the multidisciplinary team. Care plans identify individual needs and outline in detail how these needs are being met and the action required. Daily records are maintained of the care provided by individual carers. Risk assessments are in place to promote safety, but do not restrict resident’s independence. Examples of risk assessments were seen for home, leisure and community activities. The staff team encourage residents to make decisions regarding all aspects of their daily lives. Residents are supported to decide when they get up and when they want to lie in, what time they like to bath or shower, the clothes Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 12 they wear and what time they go to bed. They are supported to attend college and have input into the choice of classes they attend there. They are also encouraged to decide how they spend their leisure time and where. The manager demonstrated a selection of symbols and pictures the staff use to help residents with decision making, for example pictures of food and drinks. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity for personal development and appropriate activities are provided. Family and friendship links are maintained. The dietary need of the residents is being met. EVIDENCE: Individual activity programmes are in place, which have been discussed with residents. Some people attend Crawley College on various days during the week. Other activities include “mud pie” pottery class, Holmbush Farm, horse riding, and home living skills. Leisure time includes going to the cinema, swimming, dance nights, health and fitness, walking, eating out, and shopping. The home has its own transport which is used daily. Holidays are arranged and the residents went to Disneyland Paris for their last holiday and are looking at Devon for their next one. Family links are maintained and visitors are welcome in the home at any reasonable time. Relatives are invited to care reviews and are actively involved in care planning. Some residents go home for occasional weekends Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 14 and for special events for example Christmas. Residents have the facility to receive telephone calls and frequently ring home. Friendship groups are also supported and friends are welcome to visit individual residents at various times. A resident from another home was visiting during the inspection. Spiritual preferences of the residents are noted but currently no resident actively practices their faith. One resident is Muslim and his parents ask that his religion be respected. The manager stated that the home tries to observe their wishes whenever possible in accordance with freedom of choice. The residents plan the menus with support from the staff. Each week during a meeting, residents are encouraged to choose the meals using a selection of photographs and symbols. The choice of food is wholesome, nutritious and varied. Residents are encouraged to follow a healthy eating plan, and there is access to a dietician for advice. Two residents accompany staff to do the shopping. The manager stated that whenever possible residents are encouraged to participate in the preparation of meals, some lay the tables and others clear away and stack the dishwasher. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Physical, and emotional needs of residents are supported as outlined in individual care plans. Appropriate arrangements are in place to meet the health care needs of residents. The medication practice in the home is satisfactory. EVIDENCE: The physical and emotional needs of residents are being met as outlined in individual care plans. All the residents are registered with a local GP surgery and can visit there when required. Specialist input, for example, psychology, the epilepsy clinic, physiotherapy, and dietician can be accessed at the local resource centre. Residents can visit the dentist by appointment and staff have been trained to cut residents’ toenails. The home has a policy in place for the administration of medication. Lloyds Pharmacy supplies medication to the home. The Pharmacist also undertakes monthly audits of medication and provided training in the administration of medication to all the staff. On completion of this training certificates of competency are issued. The medication recording charts were seen and are well maintained. Currently there are no residents in the home that self medicate. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service can be confident that their concerns and complaints are listened to and acted upon. Residents are protected from abuse. EVIDENCE: The home has a complaints procedure in place, which is also available in symbol format. This outlines the procedure to be followed in the event of a complaint and the timescales involved. The manager stated that no complaints had been received by the home. The commission has not received any complaints since the last inspection. The home has an abuse awareness policy in place and all staff undertake abuse awareness training as part of their induction training. There is also a copy of Surrey’s Multi Agencies Policies and Procedures on Safeguarding Vulnerable Adults in place and the manager has attended the local authority training regarding this. The deputy manager is currently awaiting a place on this training. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28, and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, homely, and well-maintained home that meets their individual and collective environmental needs. The standard of cleanliness throughout the home is good. EVIDENCE: The home offers a high standard of accommodation for the residents. The lounge is comfortably furnished and residents stated that they like to watch television there. This overlooks a large well- maintained garden with, garden furniture, summerhouse and swings. The dining room/ kitchen is open plan and domestic in nature. It has been redesigned and fitted to meet the mobility needs of some of the residents in the home. Individual accommodation is provided in single rooms. Most of the rooms have been furnished to a good standard and personalised to reflect individual interests and hobbies. Two bedrooms are less personal which is the choice of the residents living in them. The standard of hygiene and cleanliness throughout the home is good. Residents are supported to keep their rooms clean and tidy and the communal Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 18 areas of the home are cleaned by staff with input from residents. One resident stated that he likes to keep his room clean. The laundry is well equipped to meet the requirements of the home. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A competent and trained staff team in sufficient numbers support residents to meet their assessed needs. The recruitment procedure in place protects the residents living in the home. EVIDENCE: The staff duty rota was seen and indicated that at least three staff are on duty throughout the day to support residents with their care needs and enable them to attend various planned activities. On the first day of the inspection four staff were attending a Makaton sign language training day and other staff were escorting residents on activities outside the home. The inspector arranged to revisit following the weekend to talk with more staff and residents. All staff have a training and development file which contains evidence of all the training undertaken and certificates of competence. Staff confirmed the induction training process, and the mandatory training undertaken. Over 50 of staff have an NVQ level 2 and one staff member stated that she was waiting to undertake NVQ level 3. Staff were able to explain the abuse awareness policy. The service has a recruitment policy in place, which protects the residents living in the home. Two staff files were randomly sampled, and were well Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 20 maintained. They contained all the required documents for employment legislation including an application form, two written references, an employment history and a CRB (Criminal Records Bureau) disclosure. Staff spoken to confirmed their recruitment process and how they were not allowed to work alone until their CRB had been obtained. Formal staff supervision is in place. The deputy manager undertakes this at least every two months. The home manager undertakes staff appraisal annually. This is recorded and confidentiality maintained. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed in the best interests of the residents. Health, safety and welfare of the residents and staff are promoted. EVIDENCE: The home is well managed by an experienced manager who has completed his Registered Managers Award (RMA) since the last inspection. He operates an open and inclusive management style. He has the support of an experienced deputy manager, the organisation general manager, and the provider. Staff felt supported by the management structure within the home, and stated that they would not hesitate to approach the manager with a problem or concern. Quality assurance is monitored by weekly residents meetings, regular reviews of care by staff and care managers, monthly health and safety audits, and feedback surveys. Health and safety are promoted and there is a wide range of risk assessments in place for all identified risks and safe working practice. All staff undertake Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 22 induction training in health and safety, which is updated annually. This includes first aid, manual handling, food hygiene, infection control, and medication administration. Fire safety is observed and fire alarms are tested regularly. There is a contract in place for the maintenance of fire fighting equipment. All staff undertake fire safety training yearly. Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? 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. Refer to Standard Good Practice Recommendations Chippings DS0000013601.V352123.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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. 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