Latest Inspection
This is the latest available inspection report for this service, carried out on 15th April 2009. CQC found this care home to be providing an Good service.
The inspector made no statutory requirements on the home as a result of this inspection
and there were no outstanding actions from the previous inspection report.
For extracts, read the latest CQC inspection for Chiswell Residential Home.
What the care home does well All six residents appeared content and well cared for. Some of the residents have limited verbal communication but the staff are able to understand them and assist them accordingly. Some of the comments received include: "I am well. I like watching television." "They take care of me." "They are alright." "They help me." The members of staff interviewed have a good knowledge of the assessed needs of each resident. Team working was evident and the members of staff interacted well with the residents. The home is well supported by the Hertfordshire Mental Health Team and the Community Psychiatric Nurse visits the residents regularly and provides regular inhouse training on mental health issues. The premises are well maintained, clean and have a homely atmosphere. The residents have access to all communal areas including the attractive rear garden. There is a full hand rail installed in the back garden for residents to negotiate the ramps with confidence and safety. What has improved since the last inspection? Since the last inspection there have been no hospital admissions and no incidents of falls. There is a rolling maintenance programme. Since the last inspection, the flooring in the hallway and the lounge have been replaced with non-slip heavy vinyl flooring and some matching lino in the dining area. What the care home could do better: In order to ensure the safe administration of medication, the Medication Administration Record (MAR) chart should be signed as soon as the medication has been administered to a resident and proper recording of the dosage should be made in the case of a PRN (when required) medicine. Since the inspection, the manager has retrained the staff to ensure the MAR charts are filled in clearly and appropriately. Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Chiswell Residential Home 193 Watford Road St. Albans Hertfordshire AL2 3HH The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Yoke-Lan Jackson
Date: 1 5 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home
Name of care home: Address: Chiswell Residential Home 193 Watford Road St. Albans Hertfordshire AL2 3HH 01727856153 01727848472 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs S Dewing care home 6 Number of places (if applicable): Under 65 Over 65 6 6 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 0 All care staff must receive certified training in Mental Health care. The registration category MD(E) only applies to named service users and will revert back when the named service users are no longer residing in the home. The registration category of MD(E) applies only to the service users currently resident in the home. Date of last inspection Brief description of the care home Chiswell Home, opened in 1996, is a residential care home registered for 6 residents in the Older People category. However, there are specific conditions attached to the registration in relation to 6 service users with mental health conditions. The home is located in Chiswell Green, on the outskirts of St. Albans, close to local shops and other amenities. There are some parking spaces on the front driveway and on the side road nearby. The two-storey detached house provides 2 bedrooms on the ground floor and 4 on the Care Homes for Older People
Page 4 of 25 Brief description of the care home first floor. Each bedroom has a washbasin. The bathroom and toilet facilities are nearby. The kitchen, lounge and dining room are all on the ground floor. The small administrative office is on the first floor. There is a front lawn, and to the back of the building, there is an attractive garden with a patio. There are garden furniture and comfortable seating which are accessible to the service users. The home charges £500- £600 per week. Information about the home and the service it offers is contained in the Statement of Purpose and Service Users Guide. A copy of these and the most recent CSCI inspection report are available in the home. Care Homes for Older People Page 5 of 25 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection was carried out on 15/04/2009. The registered manager, who is also the proprietor, was not present during the site visit. The deputy manager was present. There are currently 6 people in residence. The inspection included a tour of the premises. Time was also spent observing how the staff interacted with the residents. Staff and residents were spoken to and key documents were examined. There were no visitors present during the site visit. The inspection ended with a thorough discussion with the registered manager through the telephone. Information received by us included the Annual Quality and Assurance Assessment Care Homes for Older People
Page 6 of 25 (AQAA) which providers of registered services are required to complete. The AQAA focuses on how the outcomes are being met for the people using the service and also provides us with statistical data. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 25 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective clients can be assured that a thorough pre-admission assessment will be carried out before they are admitted to ensure that the home can meet all their care needs. Evidence: Since the last inspection there have been no new admissions. The home manager, who is also the proprietor, will carry out a thorough assessment on the personal, healthcare and social care needs of a prospective client prior to admission. The home will only admit a prospective client whose care needs can be met. The pre-admission documents examined were found to be satisfactory. There is a trial period of stay of 46 weeks before the contract is finalised. Care Homes for Older People Page 11 of 25 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will be treated with respect and they will receive personal care and support in the way they prefer and require. They are safeguarded by the homes Medication Policy and Procedure. Evidence: On the day of the site visit, it was noted that all the residents seemed content and well care for. The members of staff present have knowledge of each residents likes and dislikes and each residents choices and preferences were respected. All residents have access to specialist services according to their needs. Each resident has their own doctor. The home is well supported by the Community Psychiatric Nurse who visits the residents regularly and gives staff training on mental health issues. Two residents have their blood monitored regularly by the District Nurse because of the medication prescribed. A resident with partial sight impairment has access to sight tests and appropriate aids. The small sore on the heel of a resident has healed and therefore the district nurse is no longer involved with the case. Since the last
Care Homes for Older People Page 12 of 25 Evidence: inspection there have been no hospital admissions. Each resident has a care plan. The care plans examined have details of each residents health, personal and social care needs. Appropriate risk assessments had been carried out and documented. The daily notes were examined and it was noted that some were not signed and the time of entry was not recorded by the author. Since the inspection, the daily record form has been revised to allow for more detailed entries. The key worker reviews the persons care needs and updates the written care plan monthly. There is an annual review of care needs that involves the resident, their next of kin, the social worker and the Community Psychiatric team. A trained member of staff administers the medication. The controlled drug cupboard is securely attached to the wall within a metal drug cupboard in the dining room. The home uses the Nomad System for each resident. All medicines are clearly labelled and the opening date is written on each container. The Medication Administration Record (MAR) charts were examined. It was noted that there was a gap in one of the MAR charts. The deputy manager said that the member of staff had forgotten to sign even though the medicine had been administered. It was further noted that the MAR chart for a repeat prescription for PRN (given when required) medication of co-proxamol was not filled in clearly as to when one tablet was given and when two tablets were given. Since the inspection, the repeat prescription has been reviewed by the doctor and clearer instructions have been printed on the MAR chart. The manager has since retrained the staff to ensure that proper recording is made on the MAR charts. Care Homes for Older People Page 13 of 25 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will be given the opportunity to make everyday choices and that their preferences and requests will be respected. They will be encouraged to maintain links with their friends and families and they will be encouraged to have a nutritious and balanced diet. Evidence: Residents are given choices in their daily routine and their preferences are respected. On the day of the inspection, it was noted that residents have access to all community areas. One of the residents who preferred to sit in the armchair in the dining room after lunch was allowed to do so. Two other residents later sat around the dining table eagerly waiting for their evening meal, which consisted of hot soup and a selection of sandwiches and salads, which were attractively arranged for each person and appeared appetising. The members of staff interviewed said that residents have a choice of menu and the meals provided are nutritious and wholesome. Staff interviewed said that residents were encouraged in therapeutic and stimulating activities, including walks in the garden, local shopping and outings. Once a week there is a group activity of singing and dancing organised by an outside entertainer,
Care Homes for Older People Page 14 of 25 Evidence: who also brought along two pet dogs. This weekly session has been ongoing for a number of years and is much enjoyed by the residents. The residents have their nails manicured every 2 weeks by a professional. One resident has regular visits from their spouse. Privacy is maintained during these visits to allow the couple to spend time together. Care Homes for Older People Page 15 of 25 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the service has a robust Complaints Policy and Procedure and people can be assured that their complaints will be listened to and that any concerns raised will be investigated and appropriate action will be taken. Evidence: The home has not received any complaints for some years. Residents have access to advocacy services and are able to exercise their legal rights. A residents meeting is held regularly and the management deal with any issues raised promptly and effectively. All members of staff have had training on the protection of the vulnerable, Abuse Awareness and Whistle-Blowing Policy. The home follows the joint agency Safeguarding Procedures of Hertfordshire County Council Adult Care Services. The home is not involved in the financial affairs of the residents. However, the manager assists them with their personal allowances. Individual accounts are kept and all transactions are appropriately recorded. Some residents have their own solicitors to assist them, whilst others are assisted by their relatives or friends. Care Homes for Older People Page 16 of 25 Care Homes for Older People Page 17 of 25 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they live in a homely, comfortable and safe environment and have access to both internal and external communal facilities. Evidence: The premises are well maintained, including the front and back garden. The back garden is attractively designed and is accessible to wheelchairs. The garden has garden furniture and seating for residents and their visitors and a full handrail has been installed in the back garden for residents to negotiate the ramps with confidence and safety. Since the last inspection, the flooring in the hallway and the lounge has been replaced with non-slip heavy vinyl flooring and some matching lino in the dining area. On the day of the site visit, the interior of the home appeared clean and tidy. All the bedrooms are cleaned daily and they reflect the lifestyle of the individual occupant. Care Homes for Older People Page 18 of 25 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the home has an effective staff team who will support them and can be confident that they will be safeguarded by the homes robust recruitment policy and procedure. Evidence: The homes recruitment policy and practices comply with legislation. There has been one new recruit for the night shift since the last inspection. As the registered manager was not present, the staff records were not examined on this occasion However, the members of staff interviewed confirmed that they have had Criminal Record Bureau (CRB) checks and the Protection of Vulnerable Adult (POVA) checks and that they only commenced working after these checks have been cleared. The home has an effective staff team. The skill mix of staff benefits the residents. Most of the staff have attained NVQ2 and some are currently in training for NVQ3. On the day of the site visit the deputy manager and one member of staff were present for the evening shift. There is an ongoing training programme for staff. The induction programme is in line with the Skill for Care guidelines. The members of staff interviewed confirmed that
Care Homes for Older People Page 19 of 25 Evidence: they have training and refresher courses to ensure that they have the skills and knowledge to care for the residents. Recent training included medication and infection control. All staff have had accredited training on mental health issues such as Schizophrenia, Depression, Anxiety and Challenging Behaviour. The manager is currently providing training on equality and diversity issues and members of staff are being encouraged to read information leaflets on the Mental Capacity Act and the Deprivation of Liberty issues. It was noted that the home is well supported by the Community Psychiatric Nurse from the Hertfordshire Mental Health Team who provides regular training to the staff on topics that are relevant in order to meet the needs of the current group of residents. The in-house training included topics such as The Mental Health Act and Activities for the Elderly with Mental Health problems. Care Homes for Older People Page 20 of 25 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the standards of administration and management of the service have been well maintained to meet the Statement of Purpose and support residents interests. They can be assured that their health and safety are promoted and protected. Evidence: The registered manager, who is also the proprietor, was not on site during the inspection. The deputy manager and members of staff interviewed confirmed that they are meeting the care needs of the residents including their mental healthcare needs. The general standards of administration and management of the service are well maintained. Since the inspection, the shortfalls in regard to the Medication Administration Record (MAR) charts and the daily record file for each resident have been addressed by management.
Care Homes for Older People Page 21 of 25 Evidence: The home has an annual quality assurance and monitoring system that includes survey questionnaires for residents, relatives, staff and others. Information received is collated and analysed and an annual audit report is produced. Staff handled confidential information in accordance with the Data Protection Act 1998. On the day of the site visit it was noted that all the care plans were kept in a locked cupboard in the dining room. The home is not involved in the financial affairs of the residents except for their personal allowances. All transactions are appropriately documented. The servicing records have been well maintained. The proprietor has updated all the homes policy and procedures to comply with current legislation. The Registration Certificate and the Liability Insurance Certificate are on display in the dining room. The Annual Quality Assurance Assessment (AQAA) forms issued by the Commission were received on time for this inspection. The information provided was satisfactory and they were included in this report. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 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 9 It is recommended that the Medication Administration Record (MAR) charts are recorded clearly and appropriately and that each gap is justified at the back of the MAR chart with the date and signature of the author to enable case tracking and to ensure the safe administration of medication. Care Homes for Older People Page 24 of 25 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. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!